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Conquer Cancer Health News
New Jersey Insurers To Cover Experimental Cancer Treatment 12/16/99

TRENTON, N.J. _ Louis Pennucci has seen fellow cancer patients waiting around in anguish while hospitals and insurers haggle over the costs of treatment. At 51, the wait is the last thing Pennucei wants.

Pennucci welcomed the news Thursday that New Jersey health insurers have agreed to cover medical costs for cancer patients who undergo experimental treatments.

Several other states cover some form of clinical tests, but what's different here is that the companies did so without being forced to by law.

Insurance companies for the most part do not provide coverage for clinical trials, citing their unproven nature. But cancer researchers say the more patients that are involved in such trials, the better chance they have to find answers.

"If we continue to treat patients with the same standard therapies, we will get exactly the same results," said Mary Todd, deputy director of The Cancer Institute of New Jersey. "In the treatment of cancer, it is not acceptable to follow the cookbook.

We must write new recipes. Clinical trials are the new recipes that we write for the treatment and eventual cures of cancer, and cures are what we seek and what we will deliver."

New Jersey is not the first state where cancer patients have access to clinical trials. Virginia, Illinois, have access to clinical trials. Virginia, Illinois, Maryland and Rhode Island have laws requiring insurers to cover at least some level of clinical trials for cancer, and bills are pending in several other states, according to the American Society of Clinical Oncology, which represents 14,000 cancer specialists.

Advocates for cancer patients said New Jersey's agreement could be pivotal, however, because insurers came to the table willingly.

The agreement with a coalition of insurance companies that represent about 98 percent of the state's health care market would provide an estimated 25,000 cancer patients access to federally approved clinical tests, Gov. Christie Whitman said at a news conference.

Only 3 percent of the state's 275,000 residents who live with or have survived cancer participate in clinical trials. The new program aims to increase the participation rate to 15 percent.

The agreement means insurers will pay for routine patient care costs such as physician fees, laboratory expenses, administration, and continuing evaluation of patients.

Funding for other aspects of the clinical trials usually comes from other sources, including drug companies. But many patients shy away from joining these clinical trials because they fear the cost.

"I have sat in waiting rooms, watching other people sit in mental and physical pain all day because their carrier would not cover certain costs," said Pennucci, who was diagnosed with lung cancer 19 months ago. "When you're facing cancer, another session of stress is not what you need."

Pennucci said CAT scans "can cost up to $2,000 alone," noting that the cost to patients from a clinical trial "can be zero, and can be thousands of dollars."

Paul Langevin, a spokesman for the New Jersey Association of Health Plans, which represents the IO participating insurance companies, said the agreement shows that "health care progress can be achieved without legal and regulatory mandates that so often mushroom in the heat of debate."

Cancer advocates used the New Jersey announcement to call on insurers across the nation to take similar action.

"It's time for other states to join up," said John R. Durant, executive vice president of the American Society of Clinical Oncology. "And these states are ahead of the feds. With clinical trials, we learn more rapidly what's new and what works."

Cancer patient advocates are lobbying Congress to pass legislation to allow Medicare, which covers older Americans, to also cover clinical trials. Durant said older patients are more susceptible to cancer.

Langevin said it is too early to tell if this agreement would open up the doors to coverage of clinical trials for other diseases.

Copyright© 1999 All rights reserved.