Clinical Trials Coverage for Medicaid Beneficiaries

  • Published: September 3, 2020
  • Updated: September 10, 2020

For patients with serious or life-threatening disease, having access to all treatment options—including clinical trials—is crucial to sustaining hope to cure their disease or improve their quality or quantity of life. Be The Match®/The National Marrow Donor Program® (BTM) seeks to provide equal access to clinical trials for patients on Medicaid. Both Medicare and commercial payors are required to cover the routine costs of care for patients while they are enrolled in a clinical trial; however, this protection has not been extended to Medicaid patients at the federal level.

The Clinical Trials (CT) Access bill ensures access to clinical trials for Medicaid enrollees by requiring Medicaid to cover the routine care costs of an individual participating in a clinical trial. While there is a bill introduced in Congress that would provide this protection nationwide, we are attempting a state-by-state approach given the difficultly of passing any legislation at the federal level in the current political climate.

During the 2020 legislative session in Minnesota, Be The Match®/The National Marrow Donor Program® (BTM) led a campaign to pass the CT Access bill.

BTM partnered with the American Cancer Society Cancer Action Network (ACS CAN) to build a coalition of 17 organizations that included patient advocacy groups, hospitals, doctors, and biotech companies to support the passage of the bill.

For bill authors, BTM identified a House member who is also a practicing physician, and a senator whose district includes the Mayo Clinic. These authors supported efforts by BTM and ACS CAN’s contract lobbyists to secure the bill a hearing in both the House and Senate.

Coalition members met with the Minnesota Department of Human Services, which manages the Medicaid program, who communicated that they currently cover routine care costs for clinical trial enrollees. The coalition was then able to frame the bill as codifying current practice and putting it into law as it is for individuals insured through Medicare or private plans. Furthermore, this guaranteed that there would be no cost associated with the bill.

The bill was heard in the Health and Human Services (HHS) committees in the House and Senate on March 3, 2020 and was passed unanimously in both committees. It was eventually included in a larger HHS Omnibus Bill that passed at the end of May 2020. It was signed by the governor on May 27, 2020.

Campaign tactics included mobilizing advocates to email their elected officials, hosting both in-person and virtual “Days at the Capitol” with over 100 attendees, and in-person committee testimony from organizational representatives and a patient who is on a clinical trial. The campaign was buoyed by the bipartisan nature of the issue and the breadth of coalition members who signed on in support of the bill.

Sophie Wallerstedt
Grassroots Campaign Manager
Be The Match/National Marrow Donor Program