Clinical Trial Treatment or Therapy

This policy covers routine patient care services, items, tests, procedures, medications and technology that would customarily be provided outside a clinical trial for members enrolled in qualifying clinical trials (including phases I–IV), and includes state-specific mandates such as Illinois coverage for children with diseases causing low-tone neuromuscular, neurological, or cognitive impairment and Louisiana HCSC coverage of patient costs for cancer clinical trials. Major limitations: investigational or protocol‑only interventions, sponsor‑provided items, and services solely for data collection are excluded; coverage is subject to the member’s benefit contract, plan/state applicability (Illinois applies only to fully insured plans amended/issued/renewed on or after 2025-01-01; Louisiana applies only to HCSC members residing in Louisiana), trial/sponsor qualification, and other contractual exclusions.

"Illinois (per Public Act 103-0458 / HB3809): Coverage for therapy, diagnostic testing, and equipment necessary to increase quality of life for children clinically or genetically diagnosed with any ..."