Posted 08/16/13; Modified 10/23/13
Previously, all services associated with clinical trials were excluded from coverage under the HealthChoice plans. However, for charges incurred on or after January 1, 2014, HealthChoice will cover routine patient costs associated with approved clinical trials according to the following guidelines:
- All clinical trials must be registered with www.clinicaltrials.gov or www.cancer.gov.
- Treatment diagnosis must be for cancer or other life-threatening diseases.
- Members must meet all applicable plan requirements for certification.
- Certification is required by the certification administrator and EGID HealthCare Management Unit for all clinical trials services.
- Prior authorization is required by the pharmacy administrator for all clinical trials for pharmaceuticals.
- All applicable plan limitations for coverage of non-Network care apply to routine patient care costs in clinical trials.
- Investigation items, devices, or services themselves are not covered.
For questions regarding coverage of clinical trials under the HealthChoice health plans, please contact the health claims administrator at 1-405-416-1800 or toll-free 1-800-782-5218.
For questions regarding coverage of clinical trials under the HealthChoice pharmacy plan, please contact the pharmacy benefits administrator toll-free at 1-800-903-8113.
For questions regarding certification of clinical trials under the HealthChoice health plans, please contact the certification administrator toll-free at 1-800-848-8121 and EGID HealthCare Management Unit at 1-405-717-8879 or toll-free 1-800-543-6044.