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How to Find a Clinical Trial and Understand Your Potential Out-of-Pocket Costs

Be informed guide

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What is a clinical trial?

  • A clinical trial is a research study designed to answer a scientific question, by testing new treatments or procedures or increasing our knowledge of existing treatments.
  • Without clinical trials, we would not have the medical and scientific advances that we have today.
  • This guide provides information on finding, qualifying, and paying for a clinical trial, and additional   resources to learn more.
Finding a Clinical Trial

It is important to work with your health care team to see if there is a clinical trial that might be a good fit for you. There are many resources to help you find a clinical trial, including:

Resources available to help you and your health care team find a clinical trial:

National Cancer Institute:

National Institutes of Health:

Triage Cancer Clinical Trial Matching Service:

Qualifying for a Clinical Trial

  • Just because you are eligible for a trial does not mean that you will be accepted. Some clinical trials only accept a certain number of patients, or may have specific requirements.
  • Or you may want to participate in a trial that you are not eligible for, but your health care team believes will still be helpful for you. In this case, your doctor can request a special exception to access the trial.

If you are having trouble qualifying for a clinical trial, you can ask your Health Care Provider about the Expanded Access Program:

Through the Food and Drug Administration, the Expanded Access program (also known as compassionate use) allows people access to drugs or devices that have not yet been approved by the FDA. For more information:
www.fda.gov/NewsEvents/PublicHealthFocus/ExpandedAccessCompassionateUse/default.html

Insurance Coverage for Clinical Trials

It is important to talk with your health care team and your insurance company to find out what insurance coverage you have for participating in a clinical trial and what out-of-pocket costs you might have to pay.

What Insurance Usually Covers

Most private insurance and government-sponsored plans will cover the routine costs of your health care when you participate in a clinical trial.

  • Office visits
  • Blood tests
  • Imaging scans

What Insurance May Not Cover

Most insurance companies are not required to cover costs specific to the clinical trial, such as:

  • Extra blood tests
  • Extra imaging scans
  • Extra blood tests

Most of the time, clinical trial sponsors will cover those costs.

Please Note: The services covered by insurance will vary based on the type of insurance you have and your specific plan.

Other Costs and Considerations

When deciding to participate in a clinical trial, you should also consider other factors that might impact your decisions such as: 

Where is the trial located?

Will you have additional transportation expenses (ground/air, parking, tolls, lodging, etc.)?

What is the time commitment?

Will it impact your ability to work or care for your family (minor children, aging parents, etc.)?

Additional Resources

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Disclaimer: The information on this site is intended for U.S. residents only and is provided purely for educational purposes. Health, legal, regulatory, insurance, or financial related-information provided here is not comprehensive and is not intended to provide individual guidance or replace discussions with a healthcare provider, attorney, or other experts. All decisions must be made with your advisers considering your unique situation. © Triage Cancer & Pfizer Inc. 2024 

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remove.svgremove.svg-mobileChanges to Medicare in 2025 will cap your out-of-pocket (OOP) costs for covered Part D Drugs:
  • $2,000 is the total maximum OOP cost you will pay for all your covered Part D drugs in 2025. This includes your yearly deductible.
  • You also have the option to spread your OOP costs out over the course of the year by opting-into the Medicare Prescription Payment Plan.
Medicare Prescription Payment Plan
  • You can opt-in to the Medicare Prescription Payment Plan if you have Part D coverage or a Medicare Advantage Plan with prescription drug coverage.
  • Participation is voluntary and you must opt-into the program in order to participate.

Example

Opt-in during open enrollment or anytime during the plan year

Example

No payment required at pharmacy

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Receive monthly bills from your Part D plan
How to Opt-in
  • You can opt-in by contacting your plan directly, either by phone, paper request, or online.
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