THE WHITE HOUSE
Office of the Press Secretary
MEMORANDUM FOR THE SECRETARY OF HEALTH AND HUMAN SERVICES
SUBJECT: Increasing Participation of Medicare Beneficiaries in
Promoting biomedical research and ensuring that Medicare beneficiaries receive the highest quality care possible are longstanding priorities of my Administration. Over the past 3 years, with the invaluable assistance of the Vice President, my Administration has advocated and secured funding for a budget proposal that explicitly provides for Medicare coverage of services associated with cancer clinical trials, assuring that seniors and disabled persons with cancer have access to cutting-edge treatments and helping promote the research necessary to find new treatments and cures.
Research shows that only about 1 percent of American seniors participate in clinical trials, although the elderly bear the majority of the disease burden in the United States. For example, although 63 percent of cancer patients are over 65, these older cancer patients constitute only 33 percent of all those enrolled in clinical trials. The disparity is greater for breast cancer patients -- elderly women comprise 44 percent of breast cancer patients, but only 1.6 percent of women over the age of 65 are in clinical trials for the disease. These low partici-pation rates hinder efforts to develop new therapies, because they mean that scientists often need between 3 and 5 years to enroll enough participants in a clinical trial to generate scientifically valid and statistically meaningful results.
Experts believe that coverage of all clinical trials -- not just those for cancer -- can lead to breakthroughs in diagnostics, treatments, and cures for many of the most devastating diseases afflicting millions of Americans of all ages. For example, we have made striking progress in treating and curing pediatric cancers, largely because of widespread participation in clinical trials. For decades now, well over 50 percent of pediatric cancer patients were enrolled in clinical trials, and today, 75 percent of cancers in children are curable.
One factor contributing to seniors' low participation rate in clinical trials is the Medicare program's failure to guarantee Medicare payment for the care associated with participa-tion. This uncertainty regarding reimbursement often deters patients from participating in these trials, and deters physicians and other clinicians from recruiting patients, contributing to low participation rates and slowing the develop-ment of new medical treatments and diagnostic tests that could benefit the entire Medicare population.
Last December, the Institute of Medicine (IOM) issued a report entitled "Extending Medicare Reimbursement in Clinical Trials," which recommended that Medicare explicitly cover routine patient care costs for participants in clinical trials. This and other recommendations by IOM, combined with your ongoing efforts to modernize Medicare's process to ensure coverage of new technology, prompted a review of Medicare's administrative flexibility to independently remove barriers to participation in clinical trials. Following this review, you concluded that Medicare could exercise its administrative authority to provide reimbursement for routine patient care costs associated with clinical trials.
Based on the results of your Department's review and your recommendations, as well as our shared commitment to promoting critical biomedical research and to assuring that older Americans and millions of people with disabilities have access to cutting edge medical treatments, I hereby direct the Department of Health and Human Services (HHS) to:
WILLIAM J. CLINTON
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