Should a Patient Pay Cash for an Unapproved Treatment

These are desperate times and I often get asked the question “should I pay for a treatment that my insurance company is denying”?  This often becomes an option after a patient has received standard therapy and possibly one or more clinical trials.  Often a physician has a hunch that a particular drug might have activity in mesothelioma, is approved for another cancer and not covered by your insurance plan.  A hunch unfortunately does not include a discussion of the percentage of responses that have been observed nor the toxicities observed in mesothelioma.  Unfortunately you will incur all the risk including the financial costs without a clear delineation of the risks versus the benefit.

Now suppose you elect to purchase this treatment…there are a number of areas that you need to consider.  If you are hospitalized for a non approved out of pocket drug there is a possibility that the insurance company will deny payment for your care.  You will need to check your policy and perhaps speak to an agent before you take this risk.  Insurance companies are becoming increasingly difficult to work with and they will become more so in this failing economy.   If you are stable on this drug, the unanswered question would be: is your disease in a “slow growth” phase or is the drug working?  In an area of uncertainty it would be very difficult for you to feel comfortable stopping the therapy and many of these new agents can cost upwards of 4,500 per month.  Can you afford this and is this truly in your best interests?

Phase I clinical trials are conducted at many hospitals across the country.  Insurance coverage varies but the investigator and hospital will precertify you before you can enroll in the program.   You should be well informed about any costs that you will be liable for.  Volunteering to participate in a clinical trial helps the entire mesothelioma community.  This allows for data to be collected and peer review of the reported results.  Without your volunteerism advances will not be made in treating mesothelioma.  Alimta began as a Phase I drug tested in many cancers and responses were observed in mesothelioma.  Many Phase I trials will prove to have little if any impact in mesothelioma but unless mesothelioma patients actually receive these drugs we will continue to make little headway in curing this disease.  Please call me if you have any interest in exploring your clinical trials options.  Help the community in this battle.  Though the purpose of a Phase I study is to determine the safety and tolerability of a drug, the article below provides some rationale for a benefit to the patient who participates in Phase I studies.   Let me know what you think about this issue?

~Mary Hesdorffer, NP