Bipartisan Act Could Boost Clinical Trial Coverage to Medicaid Patients

Patients on Medicaid do not have coverage for routine care on clinical trials. However, the bipartisan Clinical Treatment Act is looking to change that.

Despite the fact that nearly 20% of Americans have health insurance through Medicaid, current federal regulations do not require Medicaid to cover routine care costs for clinical trials.

Enter the Clinical Treatment Act (H.R. 913).

This week, more than 100 organizations—including the American Society of Clinical Oncology (ASCO)—urged Congress to include H.R. 913 in the forthcoming “must pass” healthcare extenders package, expected to pass this spring. The act would guarantee the coverage of clinical trial participation for all patients on Medicaid who have a life-threatening illness.

The bipartisan Clinical Treatment Act was introduced by Representative Ben Ray Luján (D-NM) and Representative Gus Bilirakis (R-FL).

Not only would the Clinical Treatment Act bring costs down for patients, but it could also help to further improve the treatment of patients with cancer and other serious illnesses. Notably, it could make clinical trials more diverse and reflective of under-represented ethnic and minority groups who tend to not be represented in clinical trials. Since Medicaid ensures many people who fall under this category, the act would open the door for fewer disparities and more validity in cancer research.

“It really cuts out a large portion of our patient population that is underserved. And also a lot of minorities. Minorities are overrepresented in Medicaid. It’s important when we look at clinical trials—especially in cancer—that we have racial and socioeconomic diversity so that it can be used in the real-word setting,” said Melissa Dillmon, MD, chair of the ASCO Government Relations Committee, in an interview with Oncology Nursing News.

And while some people may be concerned about the costliness of the act, according to a statement from ASCO, the Act will have “little to no impact to the Medicaid budget.” This is because routine care costs are standard whether or not a person is on a clinical trial. Additionally, drug and medical device manufacturers will continue to pay for the costs of investigative trials.

Dillmon said that it even has the potential to decrease Medicaid costs.

“Logically, one may think costs of care may go down. If the patient is on a clinical trial, there is no bill to Medicaid for the drug, and that’s often one of the most expensive parts of treatment.”

With organization such as ASCO, the American Medical Association, and the American Cancer Society Cancer Action Network supporting the act, along with 28 cosponsors from both parties, there are many patients and professionals who hope to see it go into the healthcare extender package, which expires May 22, 2020.

“Oncology has seen unprecedented successes right now in our treatment for cancer. We’ve had the single biggest improvement in the reduction in mortality. Our goal as physicians is to continue that fight and have even more survivors,” Dillmon said.