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Insurers, state reach pact on cancer

By Christine Jordan Sexton
1/13/2010 © Health News Florida

TALLAHASSEE—The state’s largest insurance companies on Wednesday agreed to sign a voluntary compact that requires them to continue to provide routine medical treatment to cancer patients who are participating in clinical trials. 

For the first time, the compact lays out universal requirements that insurance companies must provide to patients who undergo experimental treatment to cure their cancer, according to state Sen. Don Gaetz, the Republican from Niceville who coordinated the agreement. 

“It’s a new day for cancer patients in the state of Florida,” said John Walter, president and chief executive officer of the Leukemia and Lymphoma Society.
 
Humana, Blue Cross and Blue Shield of Florida, AvMed Health Plans, Vista Healthplan, Aetna, CIGNA and United Healthcare all signed the compact.
 
Implementation is contingent upon a letter from the attorney general’s office saying the joint action won't trigger any kind of prosecution under anti-trust laws. The letter hasn’t yet been received, but a spokesman for the Florida Association of Health Plans said it is expected soon.
 
The agreement provides coverage for patients who are in phase II, III and IV cancer clinical trials approved by the National Institutes of Health, National Cancer Institute, the Food and Drug Administration, the Veterans Administration, the Department of Defense or performed by a Florida accredited school of medicine, nursing, pharmacy or either of the two licensed children’s hospitals in the state.
 
It does not cover routine care for patients in phase 1 clinical trials. The compact is voluntary and cannot be enforced by the Office of Insurance Regulation. However, Gaetz said he is positive the industry will police itself. 

Senate President Jeff Atwater, incoming president Mike Haridopolis, R-Melbourne, and former U.S. Sen. Connie Mack were at the Tallahassee press conference announcing the agreement. Mack is a cancer survivor.

“Nearly every Floridian has seen the struggle and the pains and the costs of cancer,” said Senate President Jeff Atwater, a Republican from north Palm Beach who is running for Chief Financial Officer. “Individuals suffering and fighting cancer should not have the added stress of worrying whether or not their insurance will cover the costs of their routine care.” 

The compact comes after weeks of negotiations between Gaetz and lobbyists representing the insurance, medical, and pharmaceutical industries. Gaetz sought that agreement after discovering that some patients who had insurance lost access to coverage if they enrolled in a clinical trial. 

According to the Office of Insurance Regulation, about 2 million Floridians are covered by policies that leave them at financial risk when they enter clinical trials. Blue Cross and Blue Shield of Florida, AvMed, Vista Health Plan and Connecticut General Life were some of the insurers and HMOs that stopped providing coverage for routine care when a patient enrolled in a clinical trial.
 
According to a report by the Senate Health Regulation Committee, 23 states require routine coverage for those enrolled in clinical trials. Including Florida, five states require the coverage through special compacts or agreements with insurers. 

--Christine Jordan Sexton is co-founder of TallahasseeReporters.com.