Legitimate expectations, unreasonable beliefs, and legally mandated coverage of experimental therapy
Photographs of patients seeking contributions for expensive bone marrow transplants are an everyday image on supermarket checkout stands. Benefit concerts, newspaper stories, and community fundraisers pitch in to help patients who cannot otherwise afford expensive medical interventions. Patients with multiple myeloma lined up to testify before the Medicare Coverage Advisory Committee about the lifesaving possibilities of "their" bone marrow transplants.' Many of the patients who are the subjects of these appeals have health insurance, but their insurance has denied coverage because the care has been judged to be experimental or not reasonably medically necessary. Behind these appeals for funding lies the judgment that these patients are not receiving care to which they are entitled-at least, care to which they are sufficiently entitled to deserve community support for their fundraising efforts.
Indiana University School of Law
Experimental therapy; Mandated coverage; Off-label drug uses;
Medicine, Experimental; Medicine, Experimental -- Law and legislation; Therapeutics, Experimental; Therapeutics, Experimental -- Law and legislation;
Francis, L. (2004). Legitimate expectations, unreasonable beliefs, and legally mandated coverage of experimental therapy. Indiana Health Law Review, 1, 215-51.