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Insurer rethinking rules after chat

By Christine Jordan Sexton
11/4/2009 © Health News Florida

The state’s largest health insurer is examining its policies for providing health insurance to cancer patients who undergo clinical trials.

Chief Medical Officer Jon Gavras said the company is working with state Sen. Don Gaetz to craft a policy that would pay for the usual treatments and doctor visits for its customers who are enrolled in a clinical trial.
While the details are still being reviewed, Gavras said the coverage would have to be tailored to ensure it is targeted to people who are enrolled in approved clinical trials and that the care was appropriate. 

“It wouldn’t be a wide open mandate or a wide open opportunity for a benefit,” he said. 

Clinical trials for cancer coverage will be discussed when the Senate Health Regulation Committee meets today. The committee reported last week that 23 states legally require such coverage, and four others have signed special agreements with insurers to provide it.
Florida does not require coverage and some companies, including Blue Cross, don’t provide it. That has worked a hardship on cancer patients and the facilities that treat them, their advocates say. The issue led Gaetz to convene a meeting with all the parties last week, as Health News Florida reported.
Other companies that don’t provide the coverage, according to an Office of Insurance Regulation overview, include AvMed, Vista Health Plan and Connecticut General Life. 

Gaetz , a Republican fron Niveville, met with insurance executives last week to discuss his concerns about insurance coverage and clinical trials for cancer patients. 

Gaetz said he wanted to come to an agreement with insurance companies that spelled out what underlying basic health care should be covered when cancer patients undergo clinical trials. 

Gaetz would like to lay out the requirements in a compact that insurance companies voluntarily sign. Shy of that Gaetz said he would be willing to push a mandate through the Florida Legislature. 

“This whole issue shows how health care does evolve and what’s out there,” said Gavras. “This is part of the story and as an industry we are trying to roll with it.”