Will I Need to Pay to Be in a Clinical Trial?
Clinical trials can provide an opportunity for patients to receive the latest treatment, provide a new treatment option for those whose previous treatment didn’t work, and allow patients to be a part of research that can help guide treatment in the future. While these possibilities are exciting, it’s also important to prepare for any costs of treatment.
Types of expenses
Costs in clinical trials are divided into two categories: patient care costs and research costs. Patient care costs are expenses related to normal care of a patient, including doctor visits, hospital stays, standard treatment, laboratory tests, and imaging tests, like x-rays or magnetic resonance imaging (MRI). These expenses are usually covered by health insurance, although each individual plan has its own deductibles and limits. Research costs are expenses related to the clinical trial, including the study drug or procedure, lab tests solely for research purposes, and any additional imaging tests for research purposes. Insurance won’t cover these costs, but the trial’s sponsor may pay for them. Being a part of a clinical trial usually involves additional doctor’s visits to check on the treatment’s effectiveness and monitor for any side effects. While these visits may be covered by insurance, there may be additional expenses incurred by patients, like transportation costs or child care.1
Before you begin treatment in a clinical trial, talk to your doctor and your insurance to discover what costs will be covered. Some insurance companies require preauthorization before expenses are incurred, and you may need to provide documentation about the clinical trial for them to review. Your doctor or hospital may have someone on staff that can help you, like a financial counselor or research coordinator. These people deal with many insurance companies and are familiar with what materials insurance companies may need to approve expenses, like journal articles about the study treatment or a letter from your doctor. Keep track of any calls you make to your insurance company (including the date and who you spoke with), and keep copies of any documentation you send them. This information may be helpful later on.2
For costs that aren’t covered by the research trial or your insurance, there are organizations that may help with financial needs, including:
- Medicare – This government-assisted program can help pay for costs related to clinical trials. Medicare covers adults in the U.S. over the age of 65.
- TRICARE – TRICARE is a health benefit program for all uniformed service members and their families. TRICARE has a program for costs related to clinical trials.
- Veterans Affairs – Eligible veterans can apply for their costs related to clinical trials to be covered by the Department of Veterans Affairs.
Your doctor’s office or hospital’s financial counselor may be able to suggest additional organizations that can help in your state.
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