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 has been adopted as a permanent TRICARE benefit effective April 1, 2008 for eligible beneficiaries.

What is a cancer clinical trial?

The National Cancer Institute (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. As of April 1, 2008, the DoD Cancer Prevention and Treatment Clinical Trials Demonstration is closed to new participants. Demonstration participants who remain eligible will retain their benefits.

I am receiving benefits under the DoD Cancer Prevention and Treatment Clinical Trials Demonstration project. Do I lose any benefits on April 1?

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 after the Demonstration Project is closed to new participants on April 1, 2008. You can read more about benefits under the closed Demonstration Project here.

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. Three populations of patients are most likely to be accepted into a Phase II or III NCI-sponsored clinical trial:

• 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. Read more about how the Coordinators can help you here.

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.