For more information about insurance coverage of clinical trial costs, see this feature's main page: States That Require Health Plans to Cover Patient Care Costs in Clinical Trials.

Legislation: Senate Bill 240

Effective: March 14, 2001

What clinical trials are covered?

Phase II, III, and IV clinical trials for the early detection, treatment, palliation (supportive care), or prevention of recurrence of cancer. Trials must be approved by one of the following:

• National Institutes of Health (NIH)
• NIH cooperative group or center
• U.S. Food and Drug Administration (under an Investigational New Drug application)
• U.S. Department of Defense
• U.S. Department of Veterans Affairs
• Research entities meeting NIH grant standards.

Who is required to pay?

Private insurers, specified managed care plans, and Medicaid and other state medical assistance programs.

Other key provisions:

• Legislation is effective through July 1, 2009 (as per Senate Bill 73).
• Trial must have therapeutic intent.
• There must be a reasonable expectation that treatment will be at least as effective as standard or noninvestigational cancer treatment.
• Payment is limited to in-state or in-network costs, unless the plan covers standard out-of-state or out-of-network treatment.