Insurance Coverage for Out-of-Network Clinical Trial Costs
This act aims to ensure that individuals participating in approved clinical trials have their medical costs covered, even if they use out-of-network providers. This means patients will not pay more for these services than if they used in-network providers. These changes will take effect from January 1, 2024.
Key points
Insurers must cover routine patient costs for approved clinical trials, even if services are provided by out-of-network facilities.
Patient costs (e.g., co-payments) will be the same as if using in-network providers.
The act expands the definition of 'routine patient costs' to include consultation and referral services related to clinical trials.
These changes apply to both private group and individual health plans, and the Medicare program.
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