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Patient Assistance: Implementing Preventative Steps to Ensure Financial Wellness
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Patient Assistance: Implementing Preventative Steps to Ensure Financial Wellness

Jacqueline Cabán and Charles Lynch
An overview of patient assistance programs at Smilow Cancer Hospital at Yale-New Haven, including their innovative hospital-based explanation of benefits form, which can eliminate patient responsibilities and help expedite the turnaround times for payment processing with copay assistance.
Patient Accessibility

Cash-paying patients may have difficulties accessing medications that are marked as “limited distribution.” When a patient has barriers obtaining high-cost medications from their mandated channels, they may have the option to utilize some of the benefits of the 340B program by purchasing the medication directly from an institution’s specialty pharmacy at 340B cost.
Limited distribution can also cause confusion when patients are prescribed combination therapies. In using a combination therapy where the drugs are both limited-distribution and open-access, the entire regimen may not be filled at the same location, which can potentially cause a delay in therapy.
Lack of basic knowledge regarding the availability of industry sponsored PAPs is another hindering obstacle. Patients and providers are usually unaware that MAPs exist. Patients may be weighed down by daily stressors in addition to their health concerns, preventing them from diligently seeking out information. Additionally, the lack of PAP information available to the patient in a provider's office may be due to internal policies that prohibit branded industry information from being displayed.
A recent shift has become visible in the senior citizen patient population. Today’s seniors have slightly higher incomes in relation to their predecessors. With the inception of 401K plans in 1978, we now see seniors who are collecting social security benefits, pensions, and their 401K distributions. These can all create incomes higher than the financial criteria currently established by the pharmaceutical industry PAPs. Increasing the financial criteria would reduce some of the accessibility barriers. We find that most patients who live within their income and their savings can support a small emergency, but a cancer diagnosis can bring in a prevailing financial toxicity. The ongoing need to advocate for higher-income-limit criteria needs to be addressed at the national level. A senior patient who may now enjoy survivorship might not have financial security in the future, having exhausted their limited assets.
There is a need for a more efficient, navigable, and universal platform for a patient assistance website. This would create value and be a streamlined utilization process formatted for both patients and providers. The fruition of a common application website would assist by reducing the need to fill out poly-pharma applications and, in turn, create a more streamlined process. The concept of this platform would be similar to the Common Application used by colleges. This website would have the patient or an advocate pre-populate demographics, in addition to medications and diagnosis codes. The portal could then triage a fully completed application to the appropriate PAP.

Pharmaceutical companies have provided tools by which significant financial liabilities of many stakeholders can be eliminated. These programs are underutilized and undervalued. A field reimbursement manager can assist many practices in understanding why implementation of these tools is so critical. The knowledge of industry-sponsored programs can initiate the epiphany of potential savings for both patients and providers, although assuming ownership of such a robust program may raise some queries.
Collaborations among internal departments are critical for a program’s overall success, which requires direct patient contact and maintenance of inventory levels, ordering processes, billing functions, application processes, and overall program management. MAP implementation could assure that both the patient and provider establishments would benefit by minimizing patient financial liability while having greater access to the preferred course of therapy. The internal program start-up could begin small and grow as the need and the financial benefits are recognized. Personnel can be assigned from among current oncology pharmacy team members, patient account representatives, financial counselors, or social services departments. In the absence of an assigned individual or team, word-of-mouth advice to a patient to navigate a company's website for assistance would bring great value.
We live in a world where coupons and promo codes are frequently used on items such as food, concert tickets, and even free shipping, so why not inform a patient of a coupon that could potentially save them thousands of dollars? The potential savings of millions of dollars for patients and the provider establishments tend to be a no-brainer in a climate of lower reimbursements and greater acquisition supply costs. EBO

Jacqueline Cabán is program coordinator, Oncology and Transplant Medication Assistance, Medical Oncology Services, Smilow Cancer Hospital at Yale-New Haven.
Charles Lynch is program coordinator, Oncology and Transplant Medication Assistance, Medical Oncology Services, Smilow Cancer Hospital at Yale-New Haven.
Address correspondence to:
Jacqueline Cabán
Smilow Cancer Hospital
At Yale-New Haven Hospital
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  2. Nordrum A. Cancer drug costs hit all-time high: the $100 billion disease. International Business Times website. Published May 5, 2015. Accessed: 01/06/2016
  3. Access Health CT website. Accessed December 16, 2015.
  4. Poverty guidelines. US Department of Health and Human Services website. Accessed January 6, 2016.
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