Insurance Coverage: Missouri
Effective: August 28, 2002 (S.B. 1026); May 12, 2006 (S.B. 567 & 792)
What clinical trials are covered?
Phase II, III or IV clinical trials for the prevention, early detection, or treatment of cancer, as approved or funded by one of the following:
- National Institutes of Health (NIH)
- NIH Cooperative Group or Center
- U.S. Food and Drug Administration
- U.S. Department of Defense
- U.S. Department of Veterans Affairs
- An Institutional Review Board in Missouri that has been approved by the U.S. Department of Health and Human Services
- A qualified research entity that meets the criteria for NIH Center support grant eligibility
Who is required to pay?
Specified insurers, including health maintenance organizations.
Other key provisions:
- There must be identical or superior non-investigational treatment alternatives available before providing clinical trial treatment, and there must be a reasonable expectation that the clinical trial treatment will be superior to the non-investigational alternatives.
- Requires coverage of FDA-approved drugs and devices used in cancer clinical trials even if those drugs and devices have not been approved for use in treatment of the patient's particular condition.
- Health benefit plans may limit coverage of routine care costs of patients in phase II trials to those facilities within the plans' provider network.
- For individually underwritten health plans, the phase II provision is not mandatory but must be offered as an option.