Contacts:
Senator Mike Gloor, (402) 471-2617, mgloor@leg.ne.gov
Jan McKenzie, Nebraska Insurance Federation (402) 469-2290, janatnif@windstream.net
Vicky Cerino, University of Nebraska Medical Center (402) 559-5190 vcerino@unmc.edu
Dec. 3, 2009
Agreement among Nebraska health insurers will benefit Nebraskans
Nebraskans who are ill and considering participating in a clinical trial now will have a better idea of what their health insurance policies will cover.
An agreement, which originally started out as a legislative bill, was approved by the members of the Nebraska Insurance Federation. The agreement provides guidelines for coverage of routine care for patients enrolled in phase II, II and IV clinical trials and is a model that can be used by health insurance carriers to allow consistency in coverage.
Clinical trials produce medical breakthroughs by determining whether new methods of screening, prevention, diagnosis, or treatments can benefit patients. They are conducted in hospitals, clinics and private practice offices. Countless lives around the world have been saved and improved through advancements in medicine tested and verified through clinical trials, according to the National Institutes of Health.
Nebraska State Sen. Mike Gloor of Grand Island, and others, worked with the federation on the agreement, which makes Nebraska one of 27 states with laws or cooperative agreements.
“The idea from the beginning has been to have consistent insurance coverage that individuals, doctors and hospitals could rely on when creating a treatment regimen to combat serious illness,” Gloor said. “The goal is to be able to get treatment started right away and to have confidence in health insurance coverage for that treatment.”
Sometimes a health plan may define clinical trials as “experimental” or “investigational,” until proven safe and effective. When this happens, health insurance may not cover some of the costs of what is actually routine care which may include doctor visits, hospital stays, and tests or treatments that would be conducted even if not taking part in a clinical trial.
Much like the coverage currently afforded Medicare patients, Gloor said the language of the agreement will provide patients, as well as their physicians, a greater comfort level when considering clinical trial participation and treatment.
The federation agreement covers clinical trials that have been approved by one of five organizations — the National Institutes of Health, U.S. Food and Drug Administration, Department of Defense, Veteran’s Administration and the National Cancer Institute.
“The federation was pleased to work with Senator Gloor and health system administrators on crafting this agreement, said Jan McKenzie, executive director of the Nebraska Insurance Federation. “This agreement is another example of health care providers and insurers working together on behalf of the citizens of our state.”
Most clinical studies conducted are approved by one of these organizations, said Ken Cowan, M.D., Ph.D., director of the University of Nebraska Medical Center Eppley Cancer Center. Dr. Cowan was one of several experts asked by Gloor to testify about clinical trials before the Legislature’s Banking, Insurance and Commerce Committee.
The biggest barrier to completing studies is that not enough people take part in them, Dr. Cowan said. He said fewer than 5 percent of adults with cancer take part in clinical trials.
“A significant increase in adult cancer survivors could be seen if many more patients enrolled in clinical trials,” he said.
In 2009, more than 800 cancer medicines were being tested in clinical trials, according to the Pharmaceutical Research and Manufacturers of America. Not all will prove to be useful, but those that are may be delayed in getting approved because so few adults volunteer.
At UNMC, there are 102 active phase II, III and IV studies being conducted to test investigational medications, half of which involve cancer patients.
“I have cancer patients who had very little hope of survival, but because of their participation in a clinical trial, years were added to their lives,” Dr. Cowan said. “Patients deserve the opportunity to enroll in a clinical trial that may increase their chances of survival and ultimately the survival of others,” Dr. Cowan said.
He said the increased number of cancer survivors is related to clinical trials. Over the last 10 years, there’s been an increase in survival in patients with cancer of 1 percent every year. Survivorship has increased by about 2 percent in breast cancer patients and 3 percent in prostate cancer patients.
In the last 30 years, the survival rate of children with many types of cancer has increased 50 percent or more,” said Bruce Gordon, M.D., UNMC professor of pediatric hematology/oncology and stem cell transplantation. “The improvement has been, to a great extent due to what we have learned from large clinical trials.”
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NEBRASKA INSURANCE FEDERATION members
AFLAC
Ameritas Life Insurance Corporation
Assurity Life Insurance Company
Blue Cross/Blue Shield of Nebraska
Central National of Omaha
Central States Indemnity Co of Omaha
Central States Health & Life Company
Cornhusker Motor Club
Coventry Health Insurance Company
Farm Bureau Insurance Companies
Fidelity National Title Company
FirstComp Insurance Company
Farmers Mutal Insurance Company of Nebraska
Great West Casualty Company
Lincoln Financial Group
Lincoln Benefit Life Company
Mutual of Omaha Insurance Company
Medico Life Insurance Company
Medico Insurance Company
National Indemnity Company
Pacific Life
Physicians Mutual Insurance Company
State Farm Companies
UnitedHealthcare
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Woodmen of the World
World Insurance Company
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