Extending Medicare Reimbursement in Clinical Trials

86 Pages·2000·0.26 MB·English

Extending Medicare
Reimbursement in Clinical Trials
Committee on Routine Patient Care Costs in Clinical Trials for
Medicare Beneficiaries
Henry J. Aaron and Hellen Gelband, Editors
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing
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Support for this project was provided by the Health Care Financing Administration
(Contract No. 500-98-0275). The views presented in this report are those of the Institute
of Medicine Committee on Routine Patient Care Costs in Clinical Trials for Medicare
Beneficiaries and are not necessarily those of the funding agencies.
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COMMITTEE ON ROUTINE PATIENT CARE COSTS IN
CLINICAL TRIALS FOR MEDICARE BENEFICIARIES
HENRY J. AARON, Ph.D. (Chair), The Brookings Institution, Washington, D.C.
ROBERT M. CALIFF, M.D., Duke University Medical Center
KAY DICKERSIN, Ph.D., Brown University School of Medicine
BERTIE A. FORD, M.S., R.N., O.C.N., Amgen, Inc., Columbus, Ohio
PETER D. FOX, Ph.D., PDF Inc., Chevy Chase, Md.
LANCE LIEBMAN, L.L.B., Columbia Law School
JOHN M. LUDDEN, M.D., Harvard Medical School
ROBERT S. McDONOUGH, M.D., J.D., Aetna U.S. Healthcare, Hartford,
Conn.
WILLIAM T. McGIVNEY, Ph.D., National Comprehensive Cancer Network,
Rockledge, Pa.
ROSEMARY ROSSO, J.D., Baltimore/Washington Breast Cancer Advocacy
Group, National Breast Cancer Coalition, Washington, D.C.
ELIZABETH STONER, M.D., Merck & Co., Inc., Rahway, N.J.
ROBERT THOMPSON, M.S., M.A., Medtronic, Minneapolis, Minn.
PETER J. WHITEHOUSE, M.D., Ph.D., Case Western Reserve University
School of Medicine
Study Staff
HELLEN GELBAND, Study Director
ELLEN JOHNSON, Administrative Assistant
ANNIKA OLSSON, Research Assistant
ROBERT M. COOK-DEEGAN, Director, National Cancer Policy Board
Consultants
ALLEN DOBSON, The Lewin Group, Fairfax, Va.
ERON STURM, The Lewin Group, Fairfax, Va.
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REVIEWERS
This report has been reviewed in draft form by individuals chosen for their
diverse perspectives and technical expertise, in accordance with procedures ap-
proved by the National Research Council’s Report Review Committee. The pur-
pose of this independent review is to provide candid and critical comments that
will assist the Institute of Medicine in making the published report as sound as
possible and to ensure that the report meets institutional standards for objectiv-
ity, evidence, and responsiveness to the study charge. The review comments and
draft manuscript remain confidential to protect the integrity of the deliberative
process. The committee wishes to thank the following individuals for their par-
ticipation in the review of this report:
WADE AUBRY, M.D., The Lewin Group and University of California at San
Francisco
TOM AULT, Health Policy Alternatives, Washington, D.C.
PATRICIA A. BARR, J.D., Barr, Sternberg, and Moss, Bennington, Vt.
NORMAN DANIELS, Ph.D., Newton, Mass.
SPENCER FOREMAN, M.D., Montefiore Medical Center, Bronx, N.Y.
OLGA JONASSON, M.D., F.A.C.S., The American College of Surgeons,
Chicago
ALAN S. LICHTER, M.D., University of Michigan Medical School
JAN PLATNER, J.D., JRI Health/Justice Resource Institute, Boston
HELEN L. SMITS, M.D., Ivoryton, Conn.
ROBERT YOUNG, M.D., Fox Chase Cancer Center, Philadelphia
Although the individuals listed above have provided constructive comments
and suggestions, it must be emphasized that responsibility for the final content
of this report rests entirely with the authors and the Institute of Medicine.
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Acknowledgments
We thank the following people for providing information or other assistance
during the course of this project.
Wade Aubry University of California at San Francisco
Grant P. Bagley Health Care Financing Administration
Carmella Bocchino American Association of Health Plans
Charles A. Coltman, Jr. San Antonio Cancer Institute
Chuck Cutler Prudential HealthCare
Ronald Herberman Association of American Cancer Institutes
Doug Kamerow Agency for Health Care Policy and Research
Deborah Kamin American Society of Clinical Oncology
Allen S. Lichter University of Michigan School of Medicine
Joanne R. Less Food and Drug Administration
Sridhar Mani Montefiore Medical Center, Albert Einstein College of
Medicine
Mary McCabe National Cancer Institute
Alexa McCray National Library of Medicine
Charles J. McDonald American Cancer Society
Stephen J. Northrup Medical Device Manufacturers Association
Michael O’Connell Mayo Clinic Cancer Center
Arnold Potosky National Cancer Institute
Richard Rettig Rand Corporation
Richard L. Schilsky University of Chicago Cancer Research Center
Ellen M. Smith General Accounting Office
Fran Visco National Breast Cancer Coalition
Judith L. Wagner Congressional Budget Office
Robert C. Young Fox Chase Cancer Center
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Contents
EXECUTIVE SUMMARY ............................................................................ 1
1 CLINICAL TRIALS IN THE UNITED STATES................................ 15
Background on Clinical Trials, 15
Sponsorship of Clinical Trials, 22
Clinical Trial Protocol Review and Monitoring, 24
Costs of Patient Care in Clinical Trials, 25
Clinical Trials Registry, 27
2 PAYING FOR PATIENT CARE IN CLINICAL TRIALS.................. 30
Current Medicare Reimbursement Rules Relating to Investigational
Medical Services and Clinical Trials, 31
The Status Quo in Reimbursement, 37
Programs and Proposals for Reimbursing Patient Care Costs in
Clinical Trials, 44
Appendix: A Primer on Medicare, 48
3 RECOMMENDATIONS FOR MEDICARE CLINICAL TRIAL
REIMBURSEMENT.............................................................................. 53
Recommendations, 55
Administrative and Cost Implications, 63
Conclusion, 64
REFERENCES.......................................................................................................65
APPENDIXES
A Glossary, Acronyms, and Abbreviations, 67
B Committee Biographies, 73
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