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Knowing what co-pay assistance each patient needs and where to find it—often in short order—is key to successfully securing funding and ultimately enabling access to necessary treatment. These four key steps can help financial advocates obtain patients co-pay, premium, or travel assistance from independent patient foundations.
Cancer is one of the costliest diseases to treat in the United States. According to a 2019 survey conducted by The Mesothelioma Center, 63 percent of patients with cancer and their caregivers struggle financially following a cancer diagnosis. This struggle often continues long after a patient’s initial diagnosis into treatment, survivorship, and follow-up care. As the cost of treatment continues to rise, the financial burden that often accompanies a cancer diagnosis is growing to unsustainable levels—the cost of new cancer medications tops the charts at $100,000 or higher annually.
As the costs of cancer care increase and the burden of payment falls increasingly on patients, the services of financial navigators and advocates are becoming more important to patients’ psychosocial health. ACCC defines financial navigators as any staff member who has a role in providing financial navigation services to patients. These people can include not only financial navigators and financial counselors, but also social workers and pharmacy staff. The services of these staff members can help ease the burden of treatment costs so patients can focus on their health and not have their finances determine the type of care they receive.
Below is one oncology financial navigator’s approach to helping patients who have private/commercial insurance or Medicare better afford their treatment.
Independent Foundation Co-Pay Assistance Programs
By Aimee Hoch, LSW
Knowing what co-pay assistance each patient needs and where to find it—often in short order—is key to successfully securing funding and ultimately enabling access to necessary treatment. These four key steps can help financial advocates obtain patients co-pay, premium, or travel assistance from independent foundations.
Always have up-to-date knowledge of open funds. One of the most important steps in accessing co-pay assistance via independent foundations is knowing when funds are available. I am enrolled in the Patient Access Network Foundation's FundFinder, which is a great tool for tracking this information. I also monitor the availability of disease-specific funds from various foundations via their websites, and I receive alerts on my phone and through email in real time. Each foundation’s email newsletter notifies me of all open funds they have available. This may fill up your inbox, but it is the best way to stay on top of the availability of funds from numerous foundations.
Obtain patient permission to share their data during your initial assessment. Foundation funds open and close very quickly, so having the correct patient information and permission ahead of time allows you to act fast to apply for co-pay assistance when it becomes available. During my initial consultation with patients, I take time to educate them about their co-pay assistance options, determine whether they may qualify for and benefit from foundational assistance, and obtain their permission to act on their behalf if disease-specific funds open up. In most cases, I refer Medicare recipients to foundational assistance. But patients with commercial insurance may also qualify for funds.
Streamline the application process. When I first became a financial navigator, one of my immediate tasks was to set up my account and/or personal portal with each independent foundation I track. These accounts and online portals allow me to act fast before foundation funds close. Most foundations make staff available by phone to help with this registration, if necessary.
Organize a spreadsheet or list of patients. Keeping patient information in an organized spreadsheet or list helps you stay on top of things when applying for assistance or renewing assistance for patients. My spreadsheet includes new and current patients waiting for foundation funds. I also keep track of when patients already benefitting from funds must reapply for continued funding.
Learn about ways to help patients access financial assistance for their cancer care regardless of their insurance status.
Aimee Hoch, LSW, is an oncology financial navigator at Grand View Health in Sellersville, Pennsylvania and an ACCC Financial Advocacy Network Advisory Committee member.