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To qualify, PHS Health Plans members must be enrolled in a clinical trial
that is approved by at least one of the following organizations: The
National Institutes of Health (Stage I, II, and III); The United States Food
and Drug Administration, in the form of an investigational new drug (IND)
exemption (Stage I, II, and III); The United States Department of Defense;
or The United States Department of Veterans Affairs.
"PHS Health Plans will extend
that coverage to include routine care, such as physician fees, laboratory
expenses and expenses associated with the hospitalization, administering of
treatment and evaluation of the patient."
"PHS Health Plans wants to learn about and provide its members with the
newest treatments available for fighting cancer," said Dr. Timothy Moore, chief medical officer for PHS Health Plans. "We believe that our
support will help the medical community complete these trials more quickly
and, at the same time, ensure that our members in these trials are covered
for the routine care they require and receive this care in appropriate
facilities."
In December 1999, PHS Health Plans began covering approved clinical cancer
trials for its commercial members in New Jersey. As a health plan with
members in New Jersey, New York and Connecticut, Moore added, it was
important to also ensure that patients who worked in one state but lived in
another could get the benefit coverage they needed.
Heralded as a "model of cooperation," the New Jersey agreement — established
in conjunction with The New Jersey Association of Health Plans — set a
national precedent, as New Jersey became the first state to voluntarily
achieve coverage for routine care in all stages of cancer clinical trials.
Stage I trials determine the safest pharmaceutical dosages for a patient.
Stage II trials begin to evaluate the effectiveness of the treatment. Stage
III trials compare the new treatment to standard care to evaluate relative
efficacy and therapeutic value.
Pharmaceutical companies, research institutions and government agencies have
historically funded only the costs of protocol development and data
collection associated with clinical trials. PHS Health Plans will extend
that coverage to include routine care, such as physician fees, laboratory
expenses and expenses associated with the hospitalization, administering of
treatment and evaluation of the patient. To date, these costs have been paid
by the patient. Coverage will be subject to usual plan provisions, such as
applicable co-payments.
Physicians Health Services Inc. (doing business as PHS Health Plans) is a
subsidiary of Foundation Health Systems Inc. (NYSE:FHS), one of the
nation's largest publicly traded managed healthcare companies, serving more
than five million Americans with a broad selection of health plans and
related services.
PHS Health Plans is a full-service health plan that serves more than one
million members in the tri-state area. With a physician network comprising
more than 59,000 healthcare provider locations, PHS Health Plans is the
third-largest health plan in the Northeast, offering a full array of
open-access products and coordination for multi-region employers.
Source: PHS Health Plans Inc.
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