46 • Prescription drugs; • Physical Therapy; • Occupational Therapy; • Chiropractic care; • Osteopathic manipulative treatment; and • Athletic Trainer Services. See the sections “Athletic Trainer Services”, “Therapy Services” and “Prescription Drug Benefits at a Retail or Home Delivery (Mail Order) Pharmacy” for further details on the benefits for these services. As used in this section “Chronic pain" means pain that: • persists beyond the usual course of an acute disease or healing of an injury; or • may be associated with an acute or chronic pathologic process that causes continuous or intermittent pain for a period of months or years. Clinical Trials Benefits include coverage for services, such as routine patient care costs, given to you as a participant in an approved clinical trial if the services are Covered Services under this Plan. An “approved clinical trial” means a phase I, phase II, phase III, or phase IV clinical trial that studies the prevention, detection, or treatment of cancer or other life-threatening conditions. The term life-threatening condition means any disease or condition from which death is likely unless the disease or condition is treated. Benefits are limited to the following trials: 1. Federally funded trials approved or funded by one of the following: a. The National Institutes of Health. b. The Centers for Disease Control and Prevention. c. The Agency for Health Care Research and Quality. d. The Centers for Medicare & Medicaid Services. e. Cooperative group or center of any of the entities described in (a) through (d) or the Department of Defense or the Department of Veterans Affairs. f. A qualified non-governmental research entity identified in the guidelines issued by the National Institutes of Health for center support grants. g. Any of the following in i-iii below if the study or investigation has been reviewed and approved through a system of peer review that the Secretary of Health and Human Services determines 1) to be comparable to the system of peer review of studies and investigations used by the National Institutes of Health, and 2) assures unbiased review of the highest scientific standards by qualified individuals who have no interest in the outcome of the review. i. The Department of Veterans Affairs. ii. The Department of Defense. iii. The Department of Energy. 2. Studies or investigations done as part of an investigational new drug application reviewed by the Food and Drug Administration; 3. Studies or investigations done for drug trials, which are exempt from the investigational new drug application.
Benefit Booklet: Plan 2 Page 46 Page 48