BCBS ArizonaCommercial · Coverage · Medical Policy · AZMedium impact
Coverage Eligibility of Services Associated With a Clinical Trial For Non Grandfathered Plans
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 clinical trial under non-grandfathered group and individual plans, on and off exchange. Eligibility requires documentation that the individual or provider notified BCBSAZ of the clinical trial enrollment and that participation in any phase is voluntary, and the covered 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. Investigational medications or devices, items or services that are the subject of the clinical study or provided solely for data collection, costs of managing the research, and non-health services such as travel, transportation and lodging are not eligible for coverage.
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01REQUIREMENTS: Billing team: For usual and customary services associated with an eligible clinical trial, obtain documentation of ALL of the following: notification to BCBSAZ that the individual is enrolled in a clinical trial determined to meet applicable state or federal law, and confirmation that participation in any phase of the clinical trial is voluntary.
02Billing team: Investigational medications (except as otherwise allowed under the plan) or devices, items or services that are the subject of the clinical study or provided solely to meet the need for data collection, costs of managing the research, and non-health services such as travel, transportation and lodging 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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