Tips and Resources for Coping With Immunotherapy Treatment Costs

While it’s clear that cancer immunotherapies can be very expensive, there is help available to patients when it comes to deciding whether to take such treatments — and getting the funding to pay for them.

“Patients need to really be diligent in asking ahead of time what their out-of-pocket costs are going to be, and what resources are available to help them make informed treatment decisions, and also to receive help with this out-of-pocket cost,” says Linda House, president of the patient advocacy group Cancer Support Community. A first step for insured patients is to find out exactly what their health plans will cover, according to the Cancer Research Institute, a nonprofit focused on immunotherapy. It also can be helpful for patients to check in about money and payment options with their doctors or the social services or financial departments at their hospitals, since price reductions or payment plans may be available.

“Help is available, especially in the area of paying for drugs, in a way that may not be available in the area of copays for other services,” House continues. “Our organization and others can help them find those resources.”

To Take, or Not to Take, Immunotherapy?

*Cancer Support Community can help patients make educated, shared decisions with their health care professionals about which treatments to choose. In a meeting with Cancer Support Community experts, patients can explore that issue via the “Open to Options Treatment Decision Model.” Through this process, they can identify their goals in seeking therapy and consider treatment benefits in relation to risks such as side effects and financial toxicity, House says.

Such meetings are free and can take place over the phone or in person; to set one up, patients can call the organization’s Helpline at 888-793-9355.

Help for the Uninsured

• Medicaid programs may be able to help those who can’t afford insurance or care. Contact your local or state Department of Social Services, or welfare office.
• Partnership for Prescription Assistance, at www.pparx.org, helps qualifying patients who don’t have prescription drug coverage to get their medicines for free, or nearly for free.
• The Veterans Administration may be able to help those who have served in the military, or their dependents.

Help for the Elderly and Disabled

• BenefitsCheckUp is a program of the National Council on Aging, whose aim is to help patients over 55 years of age to pay for prescription drugs, health care and other needs. Reach them at 571-527-3900, 1-800-677-1116 or www.benefitscheckup.org.
• Medicare may be able to help. Call your local office of the Social Security Administration.

Nonprofit Funding for Cancer Care

• The American Cancer Society can provide information on programs that may help patients get drugs at a substantially lower or no cost, depending on their financial circumstances and insurance plans. Its call center can be reached any time at 800-227-2345.
• The Cancer Financial Assistance Coalition, composed of 14 organizations that help provide support, can be reached at www.cancerfac.org.
• The nonprofit advocacy group CancerCare, reachable at 800-813-HOPE, offers limited financial help to those in treatment for cancer who fall into a specific low-income category, and can also direct patients to other groups that might be able to help.
• The government’s Cancer Information Service can suggest organizations that will offer advice on financial aid. Reach it at 1-800-4-CANCER or www.cancer.gov.
• Either Cancer Support Community or the Patient Advocate Foundation — and often treating oncologists — can direct patients to financial assistance programs offered by the pharmaceutical companies that make cancer immunotherapies.
• The HealthWell Foundation provides financial assistance to insured patients living with chronic and life-altering illnesses to help them afford their medical treatments. Learn more at www.healthwellfoundation.org, or email grants@healthwellfoundation.org.
• Under the Hill-Burton program, hospitals built with the help of federal funding must treat lower-income patients. The program pays for hospital facility use for some eligible patients. Contact the Hill-Burton Hotline at the U.S. Department of Health and Human Services at 1-800-638-0742, 1-800-492-0359 (in Maryland), or www.hrsa.gov/gethealthcare/affordable/hillburton.
• The Leukemia and Lymphoma Society offers a co-pay assistance program for people with these cancers, and information on outside programs that may be able to offer financial help. It can be reached at 914-949-5213, 1-800-955-4572, infocenter@lls.org or www.lls.org.
• The Patient Access Network Foundation offers underinsured patients financial help with out-of-pocket costs. Reach it at 1-866-316-PANF (7263), contact@panfoundation.org or www.panfoundation.org.
• The Patient Advocate Foundation offers copay relief programs. It also acts as a liaison between patients and their insurers, employers and creditors to help resolve insurance, job retention and debt crisis issues related to their illnesses. To find out more about these free programs, visit patientadvocate.org, email help@patientadvocate.org, or call 1-800-532-5274.

Financial Assistance from Drug Makers

Bristol-Myers Squibb:

BMS Access Support can help patients understand and navigate their insurance coverage for cancer treatment or appeal payer decisions not to provide coverage. It also can refer patients to independent charitable foundations that may be able to provide financial support, including the Bristol-Myers Squibb Patient Assistance Foundation, a charitable organization that provides free medicine to eligible uninsured patients who have an established financial hardship. More information can be obtained by calling 1-800-861-0048 or by visiting www.BMSAccessSupport.com.

The BMS co-pay program helps eligible, commercially insured patients who have been prescribed Opdivo or Yervoy with their co-pays or co-insurance costs. Additional information can be obtained by calling 1-800-861-0048 or by visiting www.BMSAccessSupport.com.

Merck:

The Merck Patient Assistance Program may provide free Keytruda to U.S. patients who are without insurance coverage, whose insurance does not cover the drug, or who otherwise cannot afford to pay. Patients may qualify if they have a household income of $58,350 or less for individuals, $78,650 or less for couples or $119,250 or less for a family of four.

The Merck Access Program provides reimbursement support for some patients prescribed Keytruda, helping patients understand and navigate their insurance coverage for the drug. The program can help answer questions about insurance coverage, prior authorization, insurance appeals and direct patient assistance, including co-pay support for eligible patients. This program can also offer information about independent co-pay assistance foundations to which Merck donates, which provide financial assistance to eligible patients who cannot afford their cost-sharing obligations. Each independent foundation has its own independent eligibility criteria and application process. More information is available by calling 1-855-257-3932 or visiting www.merckaccessprogram-keytruda.com.

Dendreon:

Dendreon’s PROvide program offers financial assistance for patients who have commercial insurance. Patients who want to apply for this program should call Dendreon ON Call at 1-877-336-3736. A reimbursement coordinator will provide program information to patients or their providers, and assist with the application process.