Clinical trials

Applies to:

Commercial group HMO, EPO, POS and PPO plans

Commercial individual MyPriority® plans

Coverage for Priority Health Medicare Advantage members

Priority Health Medicare Advantage members are free to participate in any qualifying clinical trial that is open to Medicare beneficiaries in Original Medicare. Clinical trials are covered under Clinical Trials National Coverage Determination (NCD). Refer to the Medicare Clinical Trial Policy.

Original Medicare pays for the cost of routine services provided to a Priority Health Medicare member who joins a qualifying clinical trial. Providers should bill Original Medicare.

Definition

Coverage for routine patient care costs during a clinical trial may be a covered benefit when all of the criteria on the Clinical Trials prior authorization form are met.

Medical policy/policies

Clinical trial authorizations

See the authorization form for auth criteria.