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Sen. Don Gaetz wants Blue Cross, other insurers to cover patients in clinical trials

TALLAHASSEE — A powerful state senator wants insurance companies and health maintenance organizations to stop denying coverage of routine medical treatment, such as doctor's visits and X-rays, for Florida cancer patients participating in clinical trials.

And if the insurers won't do it voluntarily, Sen. Don Gaetz says he'll introduce a bill in the next legislative session that forces them to, according to Health News Florida, an online news service.

Gaetz, who chairs the Senate Committee on Health Regulation, called industry lobbyists to his office in the Capitol on Monday to lay down their options: work with him now to draft a voluntary agreement requiring coverage or battle him in the Legislature this spring when he pushes the bill.

"My preference is, we try to approach this issue and achieve a voluntary compact," Gaetz told the insurance, teaching hospital, cancer society and pharmaceutical lobbyists who attended the meeting. "Failing that, we will sponsor legislation. I want you to know that we will. We have to."

Deputy Insurance Commissioner Mary Beth Senkewicz, who also attended, said about 2 million Floridians are covered by policies that leave them at financial risk when they enter clinical trials, which are tests of experimental drugs and treatments that patients can try after standard treatments have not worked. Such trials are sponsored by pharmaceutical companies, medical research organizations and federal agencies.

One of the companies that excludes the coverage is the state's largest insurer, Blue Cross and Blue Shield of Florida, which has a 28.4 percent market share of insured patients in the state.

Gaetz, R-Niceville, succeeded in passing a bill last year against the fierce opposition of Blue Cross and several other insurers. The bill required them to pay doctors outside their network directly when they treat Blue Cross members, instead of routing the payments through the patients. The fight between the doctors and the insurers was so fierce it reminded many of the malpractice insurance reform disputes in the early years of this decade.

Senkewicz, who reviewed the filings of the 10 largest carriers in the state, named several other companies that don't cover patients during clinical trials: AvMed, Vista Health Plan and Connecticut General Life. Together, they account for 11 percent of the insured market.

United Health Care Insurance, the second-largest insurance carrier in the state with a 14.5 percent market share, does provide coverage. So does Aetna Health, the third-largest carrier with a nearly 14 percent market share.

The Senate Health Regulation Committee produced a report showing that 23 states require routine coverage for those enrolled in clinical trials. Four states have signed special agreements with insurers to provide coverage. That's the route Gaetz prefers, he said.

Sen. Don Gaetz wants Blue Cross, other insurers to cover patients in clinical trials 10/29/09 [Last modified: Thursday, October 29, 2009 11:20pm]
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