Improving Outcomes: How TRICARE Covers Cancer Clinical Trials

Photo By Jason W. Edwards | U.S. Army Lt. Col. Nathan McWhorter, chief of Nuclear Medicine, consults with patient, Harold G. Overstreet, retired Sgt. Maj. of the Marine Corps at Brooke Army Medical Center, Fort Sam Houston, Texas, Sept. 27, 2022. Overstreet is undergoing a new treatment for prostate cancer patients which is combined with a specific type of positron emission tomography (PET) imaging agent for prostate cancer. The PET imaging allows the doctor to see where the cancer is located as well as the extent of metastasis. The new FDA-approved prostate-specific membrane antigen (PSMA) PET imaging scan significantly improves prostate cancer detection and treatment. (U.S. Army photo by Jason W. Edwards)  

FALLS CHURCH, VA, UNITED STATES

04.22.2024

Courtesy Story

Defense Health Agency

FALLS CHURCH, Va. – If you have cancer, clinical trials can offer a path to innovative new treatments. TRICARE covers participation in cancer clinical trials sponsored by the National Cancer Institute (NCI). The NCI is the federal government’s main agency for cancer research and training.

“NCI-sponsored clinical trials are at the forefront of cancer research and care,” said Jennifer Stankovic, health systems specialist, Medical Benefits and Reimbursement Branch for the TRICARE Health Plan. “These trials give patients access to groundbreaking therapies before they may become publicly available.”

By taking part in a clinical trial, you also help improve cancer care for people in the future. Read on to learn how cancer clinical trials work and how TRICARE covers them.

What are cancer clinical trials?

Cancer clinical trials test new ways to improve cancer care, as described by the NCI. Researchers design these trials to answer key questions about cancer treatments. Cancer clinical trials usually test new treatments or new ways of using existing treatments.

The goal is to find better ways to prevent, detect, diagnose, and treat different forms of cancer. By joining a trial, you gain access to treatments still considered experimental.

TRICARE covers participation in NCI-sponsored Phase I, Phase II and Phase III cancer clinical trials. Here’s what each phase involves:

- Phase I trials test new drugs or treatments in patients with advanced cancer. These patients often have cancer that hasn’t responded to standard therapy. Phase I clinical trials establish the treatment’s safety. These trials have strict eligibility rules to ensure patient safety.
- Phase II trials test the effectiveness of a new drug or treatment. They often have more patients than Phase I trials. Researchers continue to study patient safety.
- Phase III trials compare new treatments to current standard treatments. This helps researchers see which therapy works better.

How TRICARE covers clinical cancer trials

TRICARE covers routine care associated with NCI Phase I, Phase II, and Phase III clinical trials, including:
- Tests and procedures to see if you qualify for the trial
- Related inpatient and outpatient medical care
- Diagnostic tests like lab work and imaging scans
- Services from doctors monitoring your care

Costs

TRICARE covers the costs for screenings to check if you meet the trial’s requirements. TRICARE also covers the costs of participating. If the trial is at a military hospital, you’ll receive outpatient care for free. If you participate in the trial through a TRICARE-authorized provider, you’re responsible for the same costs as other TRICARE covered services. These costs depend on who you are and your TRICARE plan.

How to participate

Ask your doctor if an NCI clinical trial may benefit you. You can also use NCI’s search tool to find clinical trials. While trials offer access to new therapies, there’s much to consider. You should weigh the participation rules and logistical demands against your own medical needs and priorities. TRICARE’s Cancer Clinical Trials page has helpful questions to start the discussion with your doctor.

If a clinical trial may be right for you, your doctor will consult the team running the trial for details. You must get pre-authorization from TRICARE to enroll in a trial.

Once you’re accepted into an NCI trial, the trial team assigns you a case manager. Your case manager helps you participate in the trial and becomes your main point of contact.

By covering NCI clinical trials, TRICARE gives you the chance to get tomorrow’s most promising cancer treatments today. Learn more about how the military health community is advancing cancer research.

Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions, and create your personalized profile to get benefit updates, news, and more.

• Date Taken: 04.22.2024
• Date Posted: 04.22.2024 11:29
• Story ID: 468887
• Location: FALLS CHURCH, VA, US