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Tips for Affording Specialty Medications

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How oncology providers can help patients overcome financial barriers to treatment.

The rapidly rising cost of specialty oncology drugs is forcing many patients to make a choice between their mortgage and their medication. It's no wonder. With monthly drug costs often totaling into the thousands - many, many thousands - more and more cancer patients have to take into account the financial impact of following a specific treatment protocol or therapy. Even with co-pay amounts factored in, costs can be steep, particularly for patients whose only insurance is Medicare, which leaves them responsible for 20 percent of the total monthly cost. And, for patients not on Medicare, it's often not until they are diagnosed and begin a treatment regimen that they realize they are underinsured and lack the resources necessary for a course of care. Financial sensitivity to high co-pay amounts can have a significant effect on adherence. The American Journal of Managed Care noted in a 2011 study that one in four cancer patients abandoned their medications when out-of-pocket costs exceeded $500.1

With the cost of specialty drugs expected to rise another 44 percent this year, what can oncology practitioners do to help mitigate costs for their patients? As Dr. Yousuf Zafar stated in ASCO Connection, "If the treatment we prescribe can result in undue financial burden, then we should address the financial burden … even if we don't have all the answers for how to reduce treatment-related costs, having the discussion might ease patients' concerns."2

Here are eight tips physicians should share with patients who may be struggling with the cost of cancer medications:

1. Understand your insurance. It's important that patients understand what coverage they have, including any out-of-pocket costs for coinsurance, co-pays and deductibles. After a diagnosis, this is a critical and necessary first step in their personal treatment path.

2. Understand your treatment - and how it's being administered. With multiple treatment paths for cancer therapy, and each one potentially having a different financial impact, it is important for patients to know where their medications are coming from and if there are any additional costs associated with unique routes of administration. For example, knowing that traditional intravenous oncology medications are covered under the medical benefit of a health plan while oral oncology drugs are typically managed under the pharmacy benefit of a health plan is important for helping a patient manage the resulting difference in co-pays and out-of-pocket costs.

3. Turn to manufacturer support programs. Connect patients undergoing treatment to manufacturer patient and co-pay assistance programs for their medications and, in some instances, additional support services that offer relief with household bills, transportation and other essentials.

4. Take a look at NeedyMeds.org. This national nonprofit information resource helps patients locate pharmaceutical assistance programs through a comprehensive website database that is free of charge to all users. The site lists more than 4,000 drugs that are available through almost 400 different patient assistance programs.

5. Use social resources. There are many new crowdsourcing and social media techniques that can help patients and caregivers raise funds for medical expenses. Mobilizing friends, family neighbors and even the community in a social sphere can create both awareness and a new realm of support.

6. Connect with caseworkers. If hospitalization or additional care services are necessary, healthcare caseworkers are another layer of support. These experts work for the hospital or health system and may be able to help patients qualify for financial assistance or evaluate different payment options, including credit.

7. Engage with a patient advocacy group. Knowledge is power. A patient advocacy group can offer insight and information into specific diseases and connect patients with others undergoing the same treatment. There are many private- or government-funded organizations that offer programs that can mitigate costs associated with specific diagnoses.

8. Stay on treatment. It's important that patients remain on therapy despite the hurdles. There are many support programs and services available that can help ease the stress and financial burden of treatment so patients can focus on what matters most - attaining and maintaining the best possible outcome during their entire therapeutic journey.

1 Landers, J. (2015, April 05). Runaway cancer drug prices raise stakes for patients. The Dallas Morning News.
2 Zafar, Y. (2013, May 24). Preparing Patients for Toxicity - Physical and Financial. Retrieved April 27, 2015.
 
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