Vermont § 4095e - Clinical trials for cancer patients

§ 4095e. Clinical trials for cancer patients

• (a) The Commissioner shall, after notice and hearing, adopt rules requiring that all health
  insurance plans issued in this State provide coverage for routine costs for covered
  individuals who participate in cancer clinical trials. (1) Any rules adopted under this section shall be limited to the coverage of routine costs
  for covered individuals 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 covered individual provides notice to the health
  insurance plan prior to participation in the clinical trial, and one or more of the
  following circumstances applies: (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 covered individual already has completed a clinical trial at one of the Vermont
  or New Hampshire cancer care providers described in subdivision (2) of this subsection
  (a) and the covered individual’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 that participation in that clinical trial would be in the best
  interests of the covered individual, even if a comparable clinical trial is available
  at that time at one or both of the Vermont or New Hampshire cancer care providers
  described in subdivision (2) of this subsection (a); or (C) the health insurance plan has already approved a referral of the covered individual
  to an out-of-network cancer care provider and an out-of-network clinical trial becomes
  available and the covered individual’s cancer care provider determines participation
  in that clinical trial would be in the best interests of the covered individual, even
  if a comparable clinical trial is available at one or both of the Vermont or New Hampshire
  cancer care providers described in subdivision (2) of this subsection (a). (4) If a covered individual participates in a clinical trial administered by a cancer
  care provider that is not in the health insurance plan’s provider network, the health
  insurance plan may require that routine follow-up care be provided within the health
  insurance plan’s network, unless the cancer care provider determines this would not
  be in the best interests of the covered individual. (b) This section shall apply to Medicaid and any other public health care assistance program
  offered or administered by the State or by any subdivision or instrumentality of the
  State. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)