Medicare HMO costs keep cancer patients out of clinical trials

The National Cancer Institute has made clinical trial participation a top national priority and yet participant levels are still not perhaps where they could be. Yes, this is a big decision for any patient/physician to make as far as whether or not to enroll, but many trials are offering lifesaving solutions, thus it pays to be informed and know what is available.

Patients are opting out due to cost, and there needs to be a better way to reach individuals, as the information gained is not only created for one person individually, the results and information will go on to help potentially save the lives of others as well. Clinical trials in the US are in a very “touchy” position, as overseas studies have been shown to be less expensive, and other countries do not have the same standards that we have here in the US, and that is also something that tends to create havoc, especially with citizens of other countries in their quest to know “how safe are the trials”, as well.

If you are not aware, check out the related reading posts below and see where Pharma is moving many trials, and why. First of all the cost is slated to be 1/5 of what a trial is here in the US, pure economics here. In short, if insurers continue to make it more difficult to attain participants here in the US, Pharma and other entities who need the information for the creation of new drugs will go overseas, and that is not any big revelation, it is what it is.

But we also have the payers looking at their overseas operations, with many of the big carriers opening up offices in China too, so you might ponder is this also part of the game plan? Just recently China stated they were looking at a country wide health plan run by the government, so who knows exactly where that will go, but overseas the input of the payers may not be as critical as to what we have here. With trials being run at 1/5 the costs, this means for the same amount of money spent in the US, they can have 5 going overseas, and perhaps for every 1 success, that allows room for 4 failures too, which is a scary thought when you think of individuals putting their trust and lives in the program to be a “test” model.

So basically what this calls for is a better working partnership between R and D of Pharma and other biotech drug companies to work with payers as a team so we don’t in fact lose our valuable clinical trials we need here in the US to other countries overseas, and with the current business models on both sides of the tables focused on sheer risk management, do you see this moving in this direction, probably not as the dollar and saving money is the driving force, and not better patient care, it’s all about each entity making a dollar to send dividends and money back to the investors.

Long and short of all of this, is that one by one as citizens here in the US, we sit powerless and watch one by one, as clinical trials leave the US and migrate to other countries, perhaps at a time when they are needed here the most. BD

The number of newly-diagnosed cancer patients age 65 and older who are enrolled in Medicare’s Health Maintenance Organization plans has increased by 6 percent within the past four years, and is shown to limit patients’ participation in clinical trials because they believe they cannot afford the plan’s out-of-pocket expense, according to a first-of-its-kind study presented Sept. 23, 2008, at the American Society for Therapeutic Radiology and Oncology’s 50th annual meeting in Boston.
While nearly two-thirds of cancer patients are age 65 and older, less than one-third of patients in this age group are enrolled in clinical trials. Health insurance coverage costs have been cited by elderly patients as reasons why they don’t enroll in clinical trials. This disparity suggests it may be related to Medicare HMO payment policy, which requires additional personal expense for clinical trial participation and may vary depending on the HMO plan. Medicare reimbursement policies differ between fee-for-service (FFS) and HMO plans.

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