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Insurance Coverage Phase I Trials - Tricare

Posts: 19
Joined: Dec 2010

I'm posting this for anyone who is covered by Tricare Health Insurance (Humana Military Healthcare). I'm participating in a Phase I Clinical Trial. Tricare has denied the authorization for participation in the trial. When I received the denial letter they referenced outdated policy (2005 manual and 32CFR199 dtd. 2002). On February 14, 2011 the Secretary of Defense posted a final ruling (32 CFR Part 199) on updated policy for Tricare to cover Phase I Clinical Trials. There are criteria which must be met. I'm currently appealing the decision and am waiting on their determination. If you get denied; appeal, appeal, appeal.


Posts: 20
Joined: May 2011

the major reason i got into a clinical trial 5 years ago was because it was paid for by the pharmiceutical companies that made the meds that were in the trial. has that changed?

Posts: 19
Joined: Dec 2010

No it has not changed. All drugs are covered by either Moffitt or the Drug company. I was informed by the "Authorizations Coordinator for transplants and clinical trials" that the decision was not based on cost. I informed her that apparently the decision was not based on my well being either. It's cheaper for the insurance company if we participate in clinical trials. I'm still waiting on the appeal decision. Should be a "no brainer" but we are dealing with a government run organziation (Tricare is under DOD).

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