BCBS ArizonaCommercial · Coverage · Medical Policy · AZ · OncologyMedium impact
Coverage Eligibility of Services Associated With a Cancer Clinical Trial
Effective date
Not stated in the notice
Identified
Jun 16, 2026
Summary
BCBSAZ covers usual and customary (standard, non-investigational) services associated with an eligible cancer clinical trial conducted within Arizona, and these services include laboratory and radiology services, physician services for consultations, medical assessments and follow-up visits, medical diagnostic and/or surgical procedures, and FDA approved medications that are approved for the requested indication or are off-label uses recognized as safe and effective by the NCCN Drugs & Biologics Compendium with Categories of Evidence and Consensus of 1 or 2A. Eligibility requires documentation that the individual or provider notified BCBSAZ of the cancer clinical trial enrollment, that the services are directly associated with the trial, and that participation in any phase is voluntary. This criteria is not applicable to non-grandfathered group and individual plans on and off exchange effective or renewed on or after January 1, 2014, which are addressed in Evidence-Based Criteria AP108.
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01REQUIREMENTS: Billing team: For usual and customary services associated with an eligible cancer clinical trial, obtain documentation of ALL of the following: the cancer clinical trial is being conducted within the state of Arizona; notification to BCBSAZ that the individual is enrolled in a cancer clinical trial determined to meet the requirements of Arizona law and that the services to be rendered are directly associated with the trial; participation in any phase of the trial is voluntary; and any out-of-network provider has agreed, via Letter of Agreement (LOA), to accept BCBSAZ reimbursement as payment in full.
02Billing team: Investigational medications (except as otherwise allowed under the plan) or devices, non-health services such as travel/transportation and/or lodging expenses, costs of managing the research of the trial, treatment or services provided outside of Arizona, and any item, device or service that is the subject of the clinical study or provided solely to meet the need for data collection and analysis are benefit plan exclusions and not eligible for coverage.
03Consequence: Lack of notification will result in administration of benefits in accordance with the other terms of the benefit plan, which may cause a denial of benefits.
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