Frequently Asked Questions
Is participation in a Cancer Clinical Trial a TRICARE benefit?
Yes. Through a new interagency agreement between the Department of Defense (DoD) and the
National Cancer Institute (NCI), participation in Cancer Clinical Trials (CCT) has been adopted
as a permanent TRICARE benefit for eligible beneficiaries.
What is a Cancer Clinical Trial?
The NCI sponsors and actively coordinates an extensive clinical trials program throughout the United States. These trials are held to
evaluate methods of prevention, early detection, treatment and supportive care for a wide range of cancers. The NCI clinical trials
program develops formal evidence in support of cancer prevention, early detection and approaches to cancer management.
Is this a new benefit? Was there previous coverage for eligible beneficiaries participating in cancer clinical trials?
The DoD Cancer Prevention and Treatment Clinical Trials Demonstration was conducted from 1996 through March 2008 and offered TRICARE
coverage for eligible beneficiaries. Although the DoD Cancer Prevention and Treatment Clinical Trials Demonstration is closed to new
participants, current Demonstration participants who remain eligible will retain their benefits. Please contact TriWest’s CCT
Coordinators at 1-866-427-6610 with any questions about continuing Demonstration benefits or eligibility.
I am receiving benefits under the DoD Cancer Prevention and Treatment Clinical Trials Demonstration project. Will I lose those benefits
now that the CCT benefit has replaced the Demonstration project?
No. As long as you were enrolled in a trial under the DoD/NCI Demonstration Project and you remain eligible to continue to participate
in the trial, your benefits will continue and remain the same even though the Demonstration Project is closed to new participants. Please
contact TriWest’s CCT Coordinators at 1-866-427-6610 with any questions about continuing Demonstration benefits or eligibility.
Who is eligible to take part in a Cancer Clinical Trial?
Active duty family members as well as TRICARE-eligible retirees and their families may participate in NCI-sponsored Phase II or Phase
III cancer prevention or clinical treatment trials at approved facilities.
Patients will also have to meet the trial participation criteria. The patients most likely to be accepted into a Phase II or III NCI-sponsored
clinical trial are:
- Those who have high-risk factors for developing cancer, such as family history of breast or colon cancer.
- Those with a new diagnosis of cancer who have not begun any treatment for their disease.
- Those who have completed a standard treatment protocol, but who continue to have disease progression.
What types of clinical trials are eligible for the TRICARE benefit?
There are three phases of cancer clinical trials:
- Phase I studies, which are primarily concerned with assessing a drug’s safety, are not covered currently by the
DoD due to their highly experimental nature.
- TRICARE beneficiaries may participate in Phase II trials, which study the safety and effectiveness of an agent or intervention
on a particular type of cancer, and evaluate how it affects the human body.
- TRICARE beneficiaries may also participate in Phase III trials, which compare a promising new treatment against the
standard approach. These studies also focus on a particular type of cancer.
What does it cost to participate in a clinical trial?
TRICARE will cost-share all medical care and testing required to determine eligibility for an NCI-sponsored trial. All medical care
required as a result of participation in a trial is subject to TRICARE copayments, cost-shares and deductibles (as applicable), provided
the following conditions are met:
- The TRICARE beneficiary obtains prior authorization for the proposed treatment before the initial evaluation
- The treatments are part of NCI-sponsored Phase II or Phase III trials
- The patient continues to meet the criteria for the trial
- The institutional and individual providers are TRICARE-authorized providers.
You can read more about the costs under your specific TRICARE program
here.
Are clinical trials safe?
National Cancer Institute-sponsored trials have several procedures to protect the safety of participants. Two review groups, the NCI
and the Institutional Review Board (IRB), serve as neutral reviewers to ensure that no patients are likely to be harmed. A separate
committee reviews test results, monitors participant safety and will decide whether the study continues.
How do I participate in a clinical trial?
Prior authorization is required to participate in an NCI clinical trial. Before beginning the evaluation or any treatment under the
clinical trial, contact a TriWest Cancer Clinical Trial Coordinator at 1-866-427-6610. A CCT Coordinator can search for TRICARE-eligible
clinical trials for you.
Do I need authorization before I can register in the TRICARE Cancer Clinical Trial (CCT) Benefit?
Yes. TriWest’s
CCT Coordinators will authorize coverage
for eligible beneficiaries in eligible trials.
Can coverage for a trial be approved even after participation has started?
Yes. Retroactive authorizations can be done by the
CCT Coordinator
for approved trials.
Will TRICARE cover Cancer Clinical Trials provided directly by the National Institute of Health (NIH)?
No. TRICARE coverage does not apply for clinical trials rendered at the NIH.
Will TRICARE cover a Clinical Cancer Trial for an active duty Service member?
No. If the active duty Service member’s military treatment facility (MTF) approves a cancer clinical trial, that care will be
funded by the MTF.
How do I request more information on the CCT benefit?
You may contact a CCT Coordinator directly at 1-866-427-6610, or use our online information
request form to have a CCT Coordinator contact you.
