This bill requires health insurance plans to cover out-of-network treatment costs for children with rare pediatric cancers who participate in approved clinical trials. Under the legislation, insurers must charge the same copayments or coinsurance rates as they would for in-network providers and pay the difference between their recognized amount and the patient's cost-sharing obligation. The bill applies to both private health insurance and Medicare, and the new requirements take effect for plan years and services beginning January 1, 2024. The legislation also allows the Secretary of Health and Human Services to establish a voluntary network of providers to help insurers comply with these coverage requirements. By removing financial barriers to clinical trial participation, the bill aims to improve access to experimental cancer treatments for children with rare diseases.
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