HMO Group Backs Paying Experimental Costs

The American Assn. of Health Plans, a trade group representing health maintenance organizations, said it will encourage its members to begin reimbursing patients for the cost of care for experimental treatments. The group reached agreement with the National Institutes of Health to encourage plans to cover the cost of patient care for drugs and other treatments that are undergoing the testing needed to win government approval for sale in the U.S. The agreement says the trade group will encourage reimbursement of patients in NIH-sponsored trials, “provided those costs are not substantially higher than the cost a plan would incur in the course of standard treatment” by a doctor or hospital affiliated with the health plan. The move is meant to help increase patient access to experimental treatments. Patient advocates say a lack of coverage for routine care costs discourages enrollment in clinical trials for new treatments.