Cost of cancer care is a growing concern of both patients and medical professionals.
Many patients are overwhelmed when facing a diagnosis of cancer. The second shock may be from the sticker price of treatment.
Even patients with insurance may be underinsured or face high out-of-pocket costs, especially if they need an oral medication as opposed to one delivered intravenously.
“Many patients are having trouble paying for their oral drugs,” says Erin Moaratty, chief of mission delivery at the Patient Advocate Foundation. A health care plan could require a co-pay for oral chemotherapy. A co-pay of 20 percent can result in an astronomical sum: $1,800 out of pocket for a $9,000-a-month pill.
Some states require health insurers to cover oral drugs at the same reimbursement rate as intravenous chemotherapy, but not every state has such a law. Unfortunately, the Patient Protection and Affordable Care Act, aka ObamaCare, does not address this issue, Moaratty says.
Pushing for Legislation
Anthony Lacey, a Maryland real estate agent, was barely able to cover the monthly $7,000 tab for his wife’s nine months of oral chemotherapy before she ultimately died of metastatic breast cancer in 2011. Because doctors could not find a similarly effective IV option, he exhausted his daughters’ college fund and now must sell his home.
As devastating as the experience was, Lacey was committed to helping others in the same boat. He helped push for a new law in his home state of Maryland that resulted in that oral chemotherapy being covered to the same extent as intravenous drugs. At least he has the knowledge that his fellow Marylanders will not face the awful dilemma that he did.
Reducing Medication Not the Answer
Medicare patients can also get caught in the “doughnut hole”—they have spent $2,800 on prescription drugs that are covered by Medicare–but it won’t pick up again until $4,550. Until then the financial burden is theirs.
A patient may decide that the only solution is to cut back on doses. Doctors would prefer a frank conversation about payment problems as they can explain that reduced doses may limit or negate the effect of therapy. In addition, physicians may have resources they can offer to help patients pay for their treatments. Pharmaceutical companies often have patient assistance programs for those who meet certain criteria, such as a fixed income and few resources. Your doctor, nurse, or a hospital navigator or social worker on staff, can help steer you to the right drug company contact, as can patient-oriented organizations such as the Cancer Support Community. Financial aid may also be available from the American Cancer Society or a cancer group that supports patients with a specific cancer type.
Ask About an Alternate Treatment
Your physician may also have treatment alternatives that may be less expensive. “If there’s no way to procure the medication without the patient purchasing it, it’s up to me to make a substitution,” says oncologist Lidia Schapira, MD, an oncologist at Massachusetts General Hospital in Boston. “Most of the time I can find a drug that is cheaper, and I do so.”
Tap into Assistance
There are several organizations, companies and institutions that offer financial help to patients for treatment costs. You can find many resources in our CURE Toolbox (under Special Interest/Financial and Drug Assistance) and “Drug Assistance Programs.”
Editor's note: CURE understands that costs of therapy may impact a patient's adherence to medication. A special supplement from CURE, which will look at barriers and improvements to adherence will be available in Spring 2013.