Clinical Trials and Health Insurance

patientx · Post by **patientx** » Thu Sep 11, 2008 10:43 am

A question for anybody that's participated in a trial or looked into one. Did you have to coordinate with your health insurance company? What was their policy? For instance, if the drug being tested caused some health problem, would the insurance company cover treatment for it?

Recently, I've been thinking about joining a study, and my insurance carrier said they would need to see information on it so they can pre-certify. I was told that they make a decision on a case by case basis, depending on the stage of the clinical trial, etc. I got the impression they would take a careful look at stage 3 trials, and that stage 1 or 2 you could forget about. What have others experiences been?

ssmme · Post by **ssmme** » Thu Sep 11, 2008 12:12 pm

I had the understanding that the trial sponsor was responsible for all care concerning the trial and any treatment necessary for side effects. I have been in the Phase IIb trial for Tovaxin and it is the sponsor (Opexa) that picks up all costs associated with the trial. Now if I were to get an unrelated illness my insurance would cover the cost of that healthcare such as an unrelated infection. I don't believe it's any of your insurance company's business unless it is explicitly stated that they will be responsible for a portion of the cost.

I am not talking about the use of a treatment/drug that is used "off label" such as Hicy. Insurance coordination is needed in that case.

Just curious...what are you contemplating?

Marcia

patientx · Post by **patientx** » Thu Sep 11, 2008 12:35 pm

I'm looking at the CombiRx trial (combining Avonex and Copaxone) and the Campath trial. If I had to do one, I'm leaning more toward the CombiRx, but Campath does sound attractive.

In the release form for the Campath trial, it explicitly states that the cost of treatment for any injury caused by the trial is the responsibility of the patient. Now, they do cover the costs of the drugs and anything they need for the trial, like MRI's, blood tests, etc. And they will make their facilities available to the patient in case treatment is needed for flareups, such as with IV steroids. But the cost is still the patient's responsibility.

whyRwehere · Post by **whyRwehere** » Fri Sep 12, 2008 9:01 am

I can't believe they are even considering mixing Avonex with Copaxone...is it a case of it doesn't really work alone, let's keep trying to make it work?

freiguy · Post by **freiguy** » Sat Sep 13, 2008 4:46 am

I am in the campath trial. It's been almost two months since the infusions and so far everything is going very well. Blood work is coming back good and I am starting to recover some of my energy. Do you know the trial name? If you have any questions feel free to ask or PM me.

patientx · Post by **patientx** » Tue Sep 16, 2008 6:34 am

I think the intent of combining Avonex and Copaxone is to see if the efficacy greatly increases over one medication alone. This trial has actually been going on for a few years now.

whyRwehere · Post by **whyRwehere** » Tue Sep 16, 2008 7:55 am

So, has their efficacy improved these last few years?