§ 4088b. Clinical trials for cancer patients

(a) The Commissioner shall, after notice and hearing, adopt rules requiring that all health benefit plans issued in this State provide coverage for routine costs for patients who participate in cancer clinical trials.

(1) Any rules adopted under this section shall be limited to the coverage of routine costs for patients who participate in a cancer clinical trial.

(2) Any rules adopted under this section shall be restricted to approved cancer clinical trials conducted under the auspices of the following cancer care providers (“cancer care providers”): The University of Vermont Medical Center, the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, and approved clinical trials administered by a hospital and its affiliated, qualified cancer care providers.

(3) For participation in clinical trials located outside Vermont, coverage under this section shall be required only if the patient provides notice to the health benefit plan prior to participation in the clinical trial, and:

(A) no clinical trial is available at the Vermont or New Hampshire cancer care providers described in subdivision (2) of this subsection (a);

(B) the patient already has completed a clinical trial under subdivision (A) of this subdivision (3) and the patient’s cancer care provider determines that a subsequent clinical trial related to the original diagnosis is available outside the health benefit plan’s network and determines participation in that clinical trial would be in the best interest of the patient, even if a comparable clinical trial is available at that time under subdivision (2) of this subsection (a); or

(C) the health benefit plan already has approved a referral of the patient to an out-of-network cancer care provider and an out-of-network clinical trial becomes available and the patient’s cancer care provider determines participation in that clinical trial would be in the best interest of the patient, even if a comparable clinical trial is available under subdivision (2) of this subsection (a).

(4) If a patient participates in a clinical trial administered by a cancer care provider that is not in the health benefit plan’s provider network, the health plan may require that routine follow-up care be provided within the health benefit plan’s network, unless the cancer care provider determines this would not be in the best interest of the patient.

(b) As used in this section, “health benefit plan” means any health insurance policy or health benefit plan offered by a health insurer as defined in 18 V.S.A. § 9402.

(c) The Vermont Agency of Human Services through its Vermont Medicaid program shall participate in the provisions of this section in the same manner as insurers as defined in 18 V.S.A. § 9402.

(d) Notwithstanding 3 Vt. Stat. Ann. chapter 25, the Commissioner shall amend rules adopted under this section for the sole purpose of eliminating any sunset provision in the rule by filing a new adopted rule with the Secretary of State and the Legislative Committee on Administrative Rules. The new adopted rule shall be effective when filed. (Added 2001, No. 10, § 1, eff. April 26, 2001; amended 2005, No. 3, § 1, eff. Feb. 24, 2005; 2015, No. 97 (Adj. Sess.), § 14.)