Year after year, the oncology community continues to see a dramatic rise in costs of cancer care, including increases in anti-cancer drug prices and patient out-of-pocket costs. Patients who are uninsured are the most vulnerable to succumbing to the financial toxicity expensive therapies can engender. In many cases, patients who do not have insurance at the time of diagnosis but who do qualify for Medicaid or Medicare can access coverage through these programs via a financial advocate or social worker at their treatment site. What assistance is available for patients who cannot pay for treatment and do not qualify for government-funded insurance?
ACCC worked with members of the ACCC Financial Advocacy Network to provide guidance to financial advocates on how to help patients access much-needed financial assistance regardless of their insurance status. Below, a financial navigator at Lake Region Healthcare in the Cancer Care and Research Center in Fergus Fall, Minn., discusses how to help uninsured patients access their anti-cancer treatment if they are not eligible for Medicare or Medicaid.
Helping Patients Access Drug Manufacturer Patient Assistance Programs
By Jeanie Troy
When I receive a new patient notification for an uninsured patient, my first task is to determine if they are eligible for Medicaid or to purchase commercial insurance in the case of a recent life-changing event. If a patient is not eligible for insurance coverage, I make their provider aware that the patient is uninsured before their first consult with the cancer care team.
Once a provider establishes a patient’s treatment plan, they will notify me through our electronic health record, so I can begin looking for patient assistance programs (PAPs) for which the patient may be eligible. Our facility now uses a third-party program to help us streamline the financial navigation process. But before we had that tool, I would usually search the ACCC Patient Assistance & Reimbursement Guide or Google the prescribed medication’s name followed by “patient assistance program” (i.e., “Keytruda patient assistance program”). Doing this can help you find medication-specific patient assistance programs that are funded through the drug manufacturer’s charity foundation. From the medication’s manufacturer website, you can access the program’s information, including eligibility criteria and application forms that can be downloaded and faxed or completed online.
I complete an identified program’s application with the patient and collect any necessary supporting documents, such as income verification, to send to the manufacturer’s patient assistance program. From my experience, it takes on average one to two weeks to receive an approval. Some programs will send the prescribed medication directly to our facility before the patient starts treatment, while others replace the medication used from our pharmacy after the patient completes each treatment.
If I am unable to identify a manufacturer’s patient assistance program for a given medication, I investigate independent foundations that may be able to offer support to cover treatment costs. If there is available funding from a foundation, I complete the application for the patient and submit it for consideration.
The last task I do—if patients still have remaining treatment costs—is to help them apply for assistance through the Community Care Program at Lake Region Healthcare. Through Community Care, patients may be eligible to have part or all their remaining balance written off based on their household size and income. If a patient owes any balance beyond that, I work with them to set up an affordable payment plan that works for them. This ensures that patients’ costs of care will be addressed and managed accordingly, regardless of their insurance status, so they can focus on their cancer treatment and health.
Learn of more ways to help patients access financial assistance for their cancer care regardless of their insurance status.
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