🏥TRICARE Regulation Expands Coverage for Clinical Trials
TRICARE Coverage of Clinical Trials and Termination of Expanded Access Treatments
Summary
The Assistant Secretary of Defense for Health Affairs (ASD(HA)) issues this final rule regarding circumstances under which services and supplies related to emerging treatments may be covered under the TRICARE program. This rule finalizes provisions published in two interim final rules (IFRs) with request for comment, which temporarily added coverage for the treatment use of investigational drugs under U.S. Food and Drug Administration (FDA)-authorized expanded access (EA) programs when for the treatment of coronavirus disease 2019 (COVID-19) and permitted coverage of National Institute of Allergy and Infectious Disease (NIAID)-sponsored clinical trials for the treatment or prevention of COVID-19. This final rule discusses the DoD's decision not to make permanent the coverage of treatment use of investigational drugs under FDA EA programs while updating language for care associated with their administration and broadens the COVID-19 clinical trial benefit to include coverage of clinical trials sponsored or approved by any National Institutes of Health (NIH) Center or Institute to treat or prevent infectious diseases associated with a pandemic or epidemic. Lastly, the final rule expands TRICARE's clinical trial benefit by covering services and supplies provided in conjunction with Phase I, II, III, and IV clinical trials that are NIH-sponsored or approved and that involve a new treatment or cure for a specific condition or the treatment of a currently uncontrolled symptom or aspect of that condition, provided that the condition is severely debilitating, life- threatening, or a rare disease.
Agencies
- Defense Department
- N/A
Business Impact
$$$ - High
The regulation expands TRICARE's clinical trial coverage significantly, allowing owners of healthcare facilities, pharmaceutical companies, and clinical trial providers to access a wider beneficiary pool and funding for clinical trials related to urgent health emergencies. Increased coverage for NIH-sponsored and approved clinical trials promotes research participation and potential treatment development, impacting healthcare businesses directly.