The cost of cancer care can be overwhelming, and now more than ever, it’s the patients and their families who are struggling with the financial aspects of a cancer diagnosis. The cost of cancer therapies can force patients to choose between paying their bills and undergoing treatment, and some patients stop following their treatment recommendations because they cannot afford it, or they think they can’t afford it.
However, whether you have insurance or not, many programs are available today that provide financial assistance to patients with cancer, so you need to familiarize yourself with these options and resources early on. Finding someone who could help is important, so the first thing to do is ask for help.
Don’t Wait to Get Started
The best time to find out about any financial assistance is soon after being diagnosed. As soon as you are told that you have cancer, you want to start those discussions. It’s better to be proactive than reactive. If you haven’t had those discussions, it’s not too late to start now.
Financial discussions should take place wherever you are seeking treatment, and your oncologist or nurse navigator should be your first go-to for financial discussions. You always want to find out whether there are any programs that can help support the type of cancer you have, or the medications you are receiving. You will also want to know whether the cancer center provides any financial assistance of their own, such as discounts.
Patients often hesitate to talk about costs with their healthcare providers, but they shouldn’t. Before trying to figure out any financial assistance programs on your own, ask your oncologist or nurse if they have a financial navigator on staff. If a financial navigator is available, talk to that person as soon as possible.
Financial Navigators
Financial navigators are in the best position to help patients maximize their financial assistance. In addition to guiding patients through the many programs for financial support and selecting the appropriate program for them, financial navigators review patients’ insurance coverage and identify ways to improve their coverage, by adding a supplemental insurance or switching to another insurance.
If you don’t have insurance, financial navigators can help you figure out if you qualify for public aid, or help from the many national foundations. Financial navigators can also help to simplify the often-confusing application process for financial assistance or for copay cards.
As a financial navigator, I complete patients’ applications for them. They bring me whatever documentation we need, and I follow up and submit all the forms. This relieves the patient from worrying about filing forms in addition to dealing with the treatment.
If you don’t have a financial navigator where you receive treatment, check out NeedyMeds (www.needymeds.org), which is a search engine that can point you to financial assistance programs available for specific cancer drugs. Sometimes it’s just researching online about the copayment assistance programs, any of those keywords, and you will usually find some information on foundations and/or pharmaceutical companies that will help.
Foundation Assistance for Insured Patients
Financial assistance is available for insured patients and uninsured patients with cancer, but the type of assistance available for each group often depends on the type of insurance.
Foundations, such as the Patient Access Network Foundation or the Patient Assistance Foundation, primarily help insured patients with their copayment or coinsurance. Foundations help cover out-of-pocket costs for Part D prescription medications, and/or any out-of-pocket expenses for your prescription medications, as well as infusion copay and coinsurance.
In some cases, the insurance will cover infusion therapies but not oral drugs. Foundations will assist patients with both types of treatments.
All foundations have 4 criteria that they use to determine program eligibility, including cancer diagnosis, type of insurance, medications, and income level. The income level is known as the federal poverty level.
Foundations differ in the services they provide, and one foundation is not better than the other. For example, the Leukemia & Lymphoma Society is a great organization, because it will cover all costs related to treatment, such as infusion charges and the cost of premedication, whereas some foundations or societies don’t cover those costs. Other especially helpful foundations are CancerCare, Good Days, and the HealthWell Foundation.
Once you submit the bills, and as long as you submit the appropriate documentation, most foundations will reimburse you for exactly what they said they would.
Financial Assistance from Drug Companies
In addition, many drug companies offer financial assistance to patients with cancer for their own drugs. If you don’t have insurance, drug companies are your go-to for financial help, instead of foundations. Many drug companies provide patient assistance programs that can also help patients who don’t have insurance or prescription coverage to get the drugs for free, if they meet certain financial criteria.
In addition, drug companies provide other assistance to help offset the high cost of drugs, including coupons, rebates, and generic drugs at discounted prices.
Eligibility criteria vary by program, so patients need to complete an application to qualify. If you need help completing your application, check NeedyMeds, which provides a list of organizations that offer application assistance for free or for a small fee.
If you don’t have a financial navigator, ask your nurse navigator for help or check online under the name of the medication or the drug company to find the contact information for any financial support specific to the drugs you are using.
In my program, uninsured patients get the same treatment as insured patients. All our patients who don’t have insurance still get full treatment, and 10 of our current 11 patients who don’t have insurance participate in a free medication program through different drug companies.
I reach out to drug companies on behalf of our patients, and if the patient is not qualified for public help or other help, I work with the drug company to get the patient the drugs for free. So talk to your financial navigator or nurse navigator and ask for help.
