MINNEAPOLISOf the many possible reasons why cancer patients
choose not to enter clinical trials, worries about whether the cost
will be reimbursed by their health plan may actually rank low on the
list, or so the experience of Minneapolis-based UnitedHealth Group suggests.
In December of last year, the company signed an agreement with the
Coalition for National Cooperative Cancer Groups (CNCCG) to waive the
normal exclusion in its health plans for experimental or
investigational treatment for patients who enrolled in trials
sponsored by any of the cooperative groups in the CNCCG, including
The health plans include an open-access model (UnitedHealthcare),
which reimburses most of its physicians on a fee-schedule basis and
has no gatekeepers or requirements for referrals, and
Uniprise, which serves large, self-funded customers such as GE and
Coca-Cola. There are approximately 300,000 physicians in the
The CNCCG includes six of the cooperative oncology groups sponsored
by the National Cancer Institute. It has approximately 300 to 400
clinical trials ongoing at any given time.
One restriction was that the studies had to be multicenter
trials. This was because we wanted to support the most important
trials, and we felt that multicenter trials had a priority over
single-institution trials, Lee N. Newcomer, MD, senior vice
president for health policy and strategy, said in an interview.
Announcements of the agreement, which took effect in January 1999,
were sent to all health plan members (some 7 million eligible
enrollees), and participating physicians, and the agreement received
attention from both the general and oncology media.
Yet after nearly a year in place, the plan has had almost no takers.
There have been fewer than 10 inquiries, and only two patients
were actually eligible for treatment and have enrolled in a
trial, Dr. Newcomer said. It was surprising to all of us
that even with coverage, people are not enrolling in trials.
The agreement includes a provision requiring that out-of-network
institutions accept the companys regular payment rate for a
particular patients plan, so we wouldnt have to get
a new contract every time a patient had to go to a center that
wasnt within our networks, Dr. Newcomer said.
The quid pro quo is that the company agreed not to quibble over
what was necessary for the trialany care that a patient needed
we would reimburse.
UnitedHealthcare set up a pilot study to track and analyze the costs
incurred by patients enrolled in trials, and the agreement with the
CNCCG allowed for the program to be suspended if expenses were
rampantly out of control, Dr. Newcomer said. We would
then use those cost analyses to figure out our next approach.
However, with almost no members taking advantage of the plan, cost
has not, to date, been a consideration in whether or not to continue
Dr. Newcomer noted that prior to the agreement with the CNCCG,
United-Healthcare had offered to pay the costs of breast cancer
patients enrolled in national clinical trials of high-dose
chemotherapy supported by bone marrow or stem cell transplant, with
similar lack of consumer interest.
Dr. Newcomer offered several possible explanations for the low use of
the new program. Patients are often scared of trials. They may
find informed consents difficult to read. They may have to travel to
receive treatment and dont want to be away from home. He
noted that travel costs are not reimbursed.
He acknowledged that it is often difficult for medical directors,
case managers, and patients to know which trials are available.
We have a website to help patients and their doctors identify
trials for which they may be eligible, he said. And the company
is also working with cancer patient advocacy groups to educate
patients about the value of clinical trials.
I believe that clinical trials offer better care, but we must
find a way to encourage patients to enter those trials. Its not
the money that is the barrier, Dr. Newcomer concluded.