oncologist suggestions in Oregon

My local oncologist here in Central Oregon sent me to see Dr. Curti after I was diagnosed stage IV several weeks ago but the only thing he offered different was 2 clinical trials one of which I was going to proceed with but was later shot down by the Insurance company as they do not participate in clinical studies. Curti and my local both left me with the same options of Ipi-Nivo or IL2. The IL2 has to be done in Portland but Ipi-Nivo could be done locally. I don't know where you are in Oregon or how you are staged but I would consult your local first and get his opinion. Good luck, 

My local oncologist here in Central Oregon sent me to see Dr. Curti after I was diagnosed stage IV several weeks ago but the only thing he offered different was 2 clinical trials one of which I was going to proceed with but was later shot down by the Insurance company as they do not participate in clinical studies. Curti and my local both left me with the same options of Ipi-Nivo or IL2. The IL2 has to be done in Portland but Ipi-Nivo could be done locally. I don't know where you are in Oregon or how you are staged but I would consult your local first and get his opinion. Good luck, 

My local oncologist here in Central Oregon sent me to see Dr. Curti after I was diagnosed stage IV several weeks ago but the only thing he offered different was 2 clinical trials one of which I was going to proceed with but was later shot down by the Insurance company as they do not participate in clinical studies. Curti and my local both left me with the same options of Ipi-Nivo or IL2. The IL2 has to be done in Portland but Ipi-Nivo could be done locally. I don't know where you are in Oregon or how you are staged but I would consult your local first and get his opinion. Good luck, 

I thought the ACA guaranteed participation in clinical trials?

Coverage for Individuals Participating in Approved Clinical Trials  

In general, PHS Act section 2709(a),⁶ as added by the Affordable Care Act, states that if a group health plan or health insurance issuer in the group and individual health insurance market provides coverage to a qualified individual (as defined under PHS Act section 2709(b)), then such plan or issuer: (1) may not deny the qualified individual participation in an approved clinical trial with respect to the treatment of cancer or another life-threatening disease or condition; (2) may not deny (or limit or impose additional conditions on) the coverage of routine patient costs for items and services furnished in connection with participation in the trial; and (3) may not discriminate against the individual on the basis of the individual’s participation in the trial.

A qualified individual under PHS Act section 2709(b) is generally a participant or beneficiary who is eligible to participate in an approved clinical trial according to the trial protocol with respect to the treatment of cancer or another life-threatening disease or condition; and either: (1) the referring health care professional is a participating provider and has concluded that the individual’s participation in such trial would be appropriate; or (2) the participant or beneficiary provides medical and scientific information establishing that the individual’s participation in such trial would be appropriate.

I thought the ACA guaranteed participation in clinical trials?

Coverage for Individuals Participating in Approved Clinical Trials  

In general, PHS Act section 2709(a),⁶ as added by the Affordable Care Act, states that if a group health plan or health insurance issuer in the group and individual health insurance market provides coverage to a qualified individual (as defined under PHS Act section 2709(b)), then such plan or issuer: (1) may not deny the qualified individual participation in an approved clinical trial with respect to the treatment of cancer or another life-threatening disease or condition; (2) may not deny (or limit or impose additional conditions on) the coverage of routine patient costs for items and services furnished in connection with participation in the trial; and (3) may not discriminate against the individual on the basis of the individual’s participation in the trial.

A qualified individual under PHS Act section 2709(b) is generally a participant or beneficiary who is eligible to participate in an approved clinical trial according to the trial protocol with respect to the treatment of cancer or another life-threatening disease or condition; and either: (1) the referring health care professional is a participating provider and has concluded that the individual’s participation in such trial would be appropriate; or (2) the participant or beneficiary provides medical and scientific information establishing that the individual’s participation in such trial would be appropriate.

I thought the ACA guaranteed participation in clinical trials?

Coverage for Individuals Participating in Approved Clinical Trials  

In general, PHS Act section 2709(a),⁶ as added by the Affordable Care Act, states that if a group health plan or health insurance issuer in the group and individual health insurance market provides coverage to a qualified individual (as defined under PHS Act section 2709(b)), then such plan or issuer: (1) may not deny the qualified individual participation in an approved clinical trial with respect to the treatment of cancer or another life-threatening disease or condition; (2) may not deny (or limit or impose additional conditions on) the coverage of routine patient costs for items and services furnished in connection with participation in the trial; and (3) may not discriminate against the individual on the basis of the individual’s participation in the trial.

A qualified individual under PHS Act section 2709(b) is generally a participant or beneficiary who is eligible to participate in an approved clinical trial according to the trial protocol with respect to the treatment of cancer or another life-threatening disease or condition; and either: (1) the referring health care professional is a participating provider and has concluded that the individual’s participation in such trial would be appropriate; or (2) the participant or beneficiary provides medical and scientific information establishing that the individual’s participation in such trial would be appropriate.

Correct me if I am wrong but my insurance is provided to me via my wifes employer (private not government) so subject to the insurance companies own regs. Dr. Curti at the time had a face to face regarding the coverage with the ins. companies powers that be and got no where with the way their plans are written. The trial was Ipi and IL2 together, both approved drugs although the Ipi was 10 mg/kg so maybe that was the proplem. Go figure though, the Ipi was paid for by the study! I can't imagine it would be the hospital stay for the IL2. In the trial there was only 2 hospital stays versus IL2 therapy alone that has more. Its a head scratcher for sure.

Correct me if I am wrong but my insurance is provided to me via my wifes employer (private not government) so subject to the insurance companies own regs. Dr. Curti at the time had a face to face regarding the coverage with the ins. companies powers that be and got no where with the way their plans are written. The trial was Ipi and IL2 together, both approved drugs although the Ipi was 10 mg/kg so maybe that was the proplem. Go figure though, the Ipi was paid for by the study! I can't imagine it would be the hospital stay for the IL2. In the trial there was only 2 hospital stays versus IL2 therapy alone that has more. Its a head scratcher for sure.

Correct me if I am wrong but my insurance is provided to me via my wifes employer (private not government) so subject to the insurance companies own regs. Dr. Curti at the time had a face to face regarding the coverage with the ins. companies powers that be and got no where with the way their plans are written. The trial was Ipi and IL2 together, both approved drugs although the Ipi was 10 mg/kg so maybe that was the proplem. Go figure though, the Ipi was paid for by the study! I can't imagine it would be the hospital stay for the IL2. In the trial there was only 2 hospital stays versus IL2 therapy alone that has more. Its a head scratcher for sure.

From what I read here, the only real exclusion is if the health plan was in place before 2010.  This applies to group insurance as well to insurances on the exchanges, I believe.  Pre-existing conditions, lifetime limits and clinical trials were all part of reforms the ACA put into place for all plans, I thought.  Not questioning your plan in particular but it does seem to go against the policies I had thought were put in place by the ACA.  Just trying to understand this myself.

http://www.alicaremed.com/news/issuebrief/ammc_trial/

The-Impact-of-the-Affordable-Care-Act-on-Clinical-Trials.html

"Prior to January 1, 2014, when this provision took effect, many group health plans and insurers specifically excluded any costs related to “experimental” or “investigational” treatments from their policies, effectively eliminating coverage for clinical trials. This issue brief examines how the new ACA requirements are changing the landscape for clinical trials, and how care management can help patients, providers and payors make sense of the decision making process under the new law."

How does the ACA affect coverage for clinical trials?

In an unusually short but sweeping amendment, Section 2709 of the Public Health Service (PHS) Act was amended by the ACA to mandate that as of January 1, 2014, non-grandfathered health plans (i.e. those that were not in place before March 23, 2010) cannot deny a qualified individual participation in an approved clinical trial, or deny or limit the coverage of routine patient costs in connection with participation in the trial. In essence, the ACA expanded the scope of coverage for most existing health policies and prevented health plans and insurers from excluding clinical trial coverage under most circumstances.

From what I read here, the only real exclusion is if the health plan was in place before 2010.  This applies to group insurance as well to insurances on the exchanges, I believe.  Pre-existing conditions, lifetime limits and clinical trials were all part of reforms the ACA put into place for all plans, I thought.  Not questioning your plan in particular but it does seem to go against the policies I had thought were put in place by the ACA.  Just trying to understand this myself.

http://www.alicaremed.com/news/issuebrief/ammc_trial/

The-Impact-of-the-Affordable-Care-Act-on-Clinical-Trials.html

"Prior to January 1, 2014, when this provision took effect, many group health plans and insurers specifically excluded any costs related to “experimental” or “investigational” treatments from their policies, effectively eliminating coverage for clinical trials. This issue brief examines how the new ACA requirements are changing the landscape for clinical trials, and how care management can help patients, providers and payors make sense of the decision making process under the new law."

How does the ACA affect coverage for clinical trials?

In an unusually short but sweeping amendment, Section 2709 of the Public Health Service (PHS) Act was amended by the ACA to mandate that as of January 1, 2014, non-grandfathered health plans (i.e. those that were not in place before March 23, 2010) cannot deny a qualified individual participation in an approved clinical trial, or deny or limit the coverage of routine patient costs in connection with participation in the trial. In essence, the ACA expanded the scope of coverage for most existing health policies and prevented health plans and insurers from excluding clinical trial coverage under most circumstances.

From what I read here, the only real exclusion is if the health plan was in place before 2010.  This applies to group insurance as well to insurances on the exchanges, I believe.  Pre-existing conditions, lifetime limits and clinical trials were all part of reforms the ACA put into place for all plans, I thought.  Not questioning your plan in particular but it does seem to go against the policies I had thought were put in place by the ACA.  Just trying to understand this myself.

http://www.alicaremed.com/news/issuebrief/ammc_trial/

The-Impact-of-the-Affordable-Care-Act-on-Clinical-Trials.html

"Prior to January 1, 2014, when this provision took effect, many group health plans and insurers specifically excluded any costs related to “experimental” or “investigational” treatments from their policies, effectively eliminating coverage for clinical trials. This issue brief examines how the new ACA requirements are changing the landscape for clinical trials, and how care management can help patients, providers and payors make sense of the decision making process under the new law."

How does the ACA affect coverage for clinical trials?

In an unusually short but sweeping amendment, Section 2709 of the Public Health Service (PHS) Act was amended by the ACA to mandate that as of January 1, 2014, non-grandfathered health plans (i.e. those that were not in place before March 23, 2010) cannot deny a qualified individual participation in an approved clinical trial, or deny or limit the coverage of routine patient costs in connection with participation in the trial. In essence, the ACA expanded the scope of coverage for most existing health policies and prevented health plans and insurers from excluding clinical trial coverage under most circumstances.

I had to break the link apart to satisfy the spam filter.  You have to append "The-Impact-of-the-Affordable-Care-Act-on-Clinical-Trials.html" to the first line.

I had to break the link apart to satisfy the spam filter.  You have to append "The-Impact-of-the-Affordable-Care-Act-on-Clinical-Trials.html" to the first line.

I had to break the link apart to satisfy the spam filter.  You have to append "The-Impact-of-the-Affordable-Care-Act-on-Clinical-Trials.html" to the first line.