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 1026; Senate Bills 567 & 792

Effective: August 28, 2002 (S.B. 1026); May 12, 2006 (S.B. 567 & 792)

What clinical trials are covered?

Phase II, III or IV clinical trials for the prevention, early detection, or treatment of cancer, as approved or funded by one of the following:

• National Institutes of Health (NIH)
• NIH Cooperative Group or Center
• U.S. Food and Drug Administration
• U.S. Department of Defense
• U.S. Department of Veterans Affairs
• An Institutional Review Board in Missouri that has been approved by the U.S. Department of Health and Human Services
• A qualified research entitity that meets the criteria for NIH Center support grant eligibility

Who is required to pay?

Specified insurers, including health maintenance organizations.

Other key provisions:

• There must be identical or superior noninvestigational treatment alternatives available before providing clinical trial treatment, and there must be a reasonable expectation that the clinical trial treatment will be superior to the noninvestigational alternatives.
• Requires coverage of FDA-approved drugs and devices used in cancer clinical trials even if those drugs and devices have not been approved for use in treatment of the patient's particular condition.
• Health benefit plans may limit coverage of routine care costs of patients in phase II trials to those facilities within the plans' provider network.
• For individually underwritten health plans, the phase II provision is not mandatory but must be offered as an option.