Clinical trial coverage under Medicaid

Nearly 20 percent of Americans receive their health insurance coverage through Medicaid. However, unlike Medicare and private and commercial payers, Medicaid is not federally required to cover routine care costs (like physician visits and laboratory studies) for patients in clinical trials. Although 15 states require their Medicaid programs to cover these costs, there are still more than 41.6 million Medicaid patients that are potentially without this needed coverage.

Clinical trials often provide patients with life-threatening conditions the best – perhaps only – treatment option for their condition. Without the guarantee of coverage, however, many Medicaid beneficiaries do not have the latest technological and scientific advancements as a treatment option.

The bipartisan CLINICAL TREATMENT Act (H.R. 913/S. 4742) would guarantee coverage of the routine care costs of clinical trial participation for Medicaid enrollees with a life-threatening condition.

Passing the CLINICAL TREATMENT Act would:

  • Improve quality of research: Medicaid insures a large portion of people from under-represented minority and ethnic groups who are not well represented in clinical trial enrollment and are not reflected in the outcome of the clinical research. Improving the representation of this group would improve the validity of clinical research data and the quality of new treatments for all patients.
  • Reduce disparities: Covering routine costs of clinical trials for patients with Medicaid coverage could help to reduce health disparities and ensure access to the high-quality, high-value care.
  • Cover only routine costs of care: This legislation would have a minimal effect on overall care costs since, in most cases, these costs consist of coverage for care that patients would be receiving anyway. The cost of the investigational device or drug would still be covered by the trial sponsor.

Take Action

More than 100 organizations representing patients, providers, medical researchers, survivors, and their families have joined together to increase awareness of this important issue and urge lawmakers to address this significant gap in clinical trial access.

We invite you to lend your voice to educate the public and tell Congress to pass the CLINICAL TREATMENT Act. Here’s how you can help:

  • Contact your lawmakers. Visit the ACT Network and take a moment to send pre-drafted letters to your lawmakers asking them to support the CLINICAL TREATMENT Act. Please be sure to personalize your letter and share with your lawmakers how this impacts your patients
  • Share your story. Do you have a patient who was unable to participate in a clinical trial due to their Medicaid coverage? We want to hear from you. Use the ACT Network to share your story. These stories will help us illustrate why this legislation is important and why it is so critical for patients to have access to clinical trials. We are also looking to hear about patients covered by Medicaid that have been successfully enrolled in a clinical trial. All stories will remain confidential until or unless ASCO contacts you about their use.
  • Post on social media. We’ve developed sample social media content about the legislation for you to use and adapt to increase awareness of this important issue. Please use #ClinicalTrialAccess in all social media content about the bill. We have also developed a logo for the bill that you can use on Twitter, Facebook, LinkedIn, Instagram, and in other resources about the bill.
    • A person’s income shouldn’t dictate whether they can access a clinical trial. We're calling on Congress to pass the CLINICAL TREATMENT Act and put clinical trials within reach of millions of patients on Medicaid. #ClinicalTrialAccess
    • We can improve the quality of our medical research and reduce disparities at the same time. Congress, pass the CLINICAL TREATMENT Act and give every patient the opportunity to access new treatments and participate in research. #ClinicalTrialAccess
    • Clinical trials often provide the best – and sometimes only—treatment option for patients. All patients with life-threatening diseases need #ClinicalTrialAccess. #Congress, please pass the CLINICAL TREATMENT Act.
    • Thank you @repbenraylujan and @RepGusBilirakis for introducing H.R. 913, the CLINICAL TREATMENT Act. Patients with Medicaid need #ClinicalTrialAccess!

Supporting Materials