In a victory for patients with life-threatening illnesses, Maryland health insurers agreed yesterday to support legislation that would require them to pay for experimental treatments offered by researchers conducting clinical trials.
The vote by the Maryland Association of Health Maintenance Organizations to back the legislation removes the biggest opposition to its passage. The trade association's objections helped kill last year's version of the bill.
"I've got to believe our chances for passage are pretty good," said Sen. Thomas L. Bromwell, chairman of the Finance Committee and sponsor of the bill. The Baltimore County Democrat said he plans to bring it to the Senate floor by the end of next week.
The accord follows two weeks of intensive negotiations between hospital officials and insurers under the watchful eye of Bromwell and Del. Carolyn Krysiak, the Baltimore Democrat who sponsored the House bill.
The legislation is a top priority of Maryland's research hospitals, especially Johns Hopkins and the University of Maryland. Both stand to gain because the legislation will assure more stable funding for their research.
"As far as competitiveness, it's going to enhance our position," -- said Dr. Martin Abeloff, director of the Johns Hopkins Oncology Center.
Abeloff, one of several leading research scientists who lobbied heavily for the bill, said the agreement would benefit everybody in the long run.
"There is no doubt that this can be translated into better ways of preventing, diagnosing and treating human disease," he said.
Abeloff said passage of the bill would make Maryland the second state in the country to adopt such legislation.
But he said Rhode Island's law, which covers only cancer trials, ++ is not as strong as the Maryland bill, which would cover all life-threatening illnesses.
Research physicians say denials of coverage by managed care companies has made it increasingly difficult to enroll patients in clinical trials, the highly structured, peer-reviewed studies that test new medical procedures.
In many cases, Abeloff said, insurers agree to cover treatment in clinical trials only after lengthy appeals involving a great deal of // red tape. "Delays can be deadly," Abeloff said.
Dr. Barry Meisenberg, director of hematology and oncology at University of Maryland Hospital in Baltimore, said clinical trials are important to everybody -- not just the patients enrolled in them.
"Much of what we've learned about medical science has been through clinical trials, and to continue to have progress in medicine we have to have full clinical trials," said Meisenberg.
In many cases, he said, the trials lead to the discovery of less costly treatments.
Bromwell noted that because of information gained in clinical trials, the cure rate for children with acute lymphocytic leukemia is now 90 percent. Previously the disease was fatal, he said.
The senator said the issue is important to him because his father, who died of that disease, gained several months of life because of treatment he received in such a trial.
Bromwell said the HMOs often save little money by denying coverage for so-called "experimental" treatments because they still must pay for standard therapies that may not be effective.
He said the bill will include safeguards to ensure that only properly designed clinical trials will be eligible for coverage. "We're not talking about voodoo medicine here. We're talking about procedures that have been approved" by the National Institutes of Health.
D. Robert Enten, the chief lobbyist for the HMO association, said the industry ultimately decided that there were differences between the clinical trials legislation and other "mandated benefits" bills the group routinely opposes.
Enten said the industry fought last year's bill because "we didn't think it provided the checks and balances we thought should be there."
This year, he said, the insurers and hospitals were able to come up with a formula that assures that "the best and most efficient" clinical trials will be covered. He said the final language needs to be worked out, but predicted that would not be a problem.
"Once we say we'll support something, we'll go out and work for its passage," he said.
Del. Michael Busch, chairman of the Economic Matters Committee, said the agreement virtually assures House passage the legislation.
Busch, an Annapolis Democrat, said the industry made a good move in coming to agreement on a bill that might have passed without its support. "If the train is going to be there, you want to get on it and find a comfortable seat rather than getting run over by it," he said.
Pub Date: 2/21/98
