Patient Advocacy: Healthcare on your side
by Martine G. Brousse,
Healthcare
Specialist, Patient Advocate, Certified Mediator
ADVIMEDPRO
APPLYING FOR FINANCIAL
ASSISTANCE:
TIPS FOR CANCER PATIENTS
The
major cause for the high cost of cancer treatment is that of chemotherapy
drugs, oral or infused. Many treatments, also called “regimens”, include generic
options, but the promising outcomes of new patient-directed therapies, and the
growing use of leading-edge targeted drugs often come at a hefty price.
The
cost of one or two brand name drugs can often meet your deductible and/or out
of pocket liability at the first cycle (the time between your first
chemotherapy treatment and the next one). The facility or office providing the
drug will appreciate your prompt payment ... in full, as drug purchase is the
number one expense in an oncology practice.
Solutions
are available but getting approved is not enough. Unless certain conditions are
met, the largest grant will not help you pay the oncologist or the pharmacy.
Here are some tips:
1.
What’s out there?
There
are three major sources of financial assistance:
• no-cost donations
from drug manufacturers: office-dispensed free samples and free doses of
infused drugs for the uninsured. Patients with insurance policies that do not
offer coverage for the treatment may also qualify.
• Copay assistance from
those manufacturers for insurance patients with high shares of cost, in the
form of direct payments to your pharmacy or oncologist, discounts cards or
reduced fees.
• Grants from
charitable organizations to help cover your cost.
Please
note: Medicare and government-issued insurance policy holders are prohibited by
law from receiving direct assistance from manufacturers, so apply directly with private
organizations.
The
off-label (non FDA-approved) use of a drug is rarely eligible for donations or
financial aid from any entity.
Get
the list of your prescribed brand name
drugs and the associated diagnosis code, then check the list of available
programs at: http://www.nccn.org/reimbursement_resource_room/default.aspx or http://www.moasc.org/drug-assistance-programs.html or http://www.cancerfac.org/members.php
Start
with the manufacturer, as most offer specific assistance, then contact charitable
organizations. Genentech and Amgen have exceptionally well-run and generous
programs, as do private Healthwell and CancerCare.
Eligibility
guidelines, documentation requirements and application forms are available online.
2.
Apply
early
You
may apply for financial assistance covering your specific diagnosis, or
specific drugs or both. Many private funds routinely run out of money, it is
best to apply between the first and 5th of each month (or ask about a waiting
list). Make sure you attach all required documentation with your application.
If you financial circumstances have changed this year, add a letter of explanation
as most applications are based last year’s
tax return and income.
Apply,
if possible, before you first treatment. If you deductible or out of pocket are
met before you are approved, you are wasting your time. Grants are NOT retroactive, except for CancerCare (60 days).
3.
Separate
Diagnoses
You
should apply for each diagnosis and/or drug separately. One program is unlikely
to cover expenses related to another prescription or condition.
A
good example is Neupogen or Neulasta, expensive drugs used for chemo-induced
neutropenia (low white blood count). These are not considered chemotherapy, and
always require a separate application from a different fund.
You
may apply for assistance for the same drug or condition from more than one
entity.
4.
Talk
to Billing
It
is imperative you inform the billing manager about your grant. The billing
process will need to be radically altered in order to accommodate your
situation, causing an insurance denial, payment delays, additional work and
stress. This sounds complicated because it is! But unless an Explanation of
Benefit from the insurance showing the liability applied toward the drug charge
is provided, no payment can be made by the assistance program. This is the time
to become best friends with the Billing department staff. Your financial fate
literally depends on their good will!
5.
Keep
on top of things
Grants
expire after a certain number of months or $ amount. Keep track of and renew
your application as needed. Don’t assume you will
be notified, this is your responsibility, as is that of notifying all parties
of any changes.
Because
available funds have decreased, and demand growing, do notify the program when
you no longer need your grant money. It can then be dispersed before the year
is up or the limit reached. Someone in a needy situation will thank you!
* A seen on NerdWallet
© [2016] Advimedpro.
© [2016] Martine G. Brousse.
All rights reserved.
My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements.
AdvimedPro (424) 999 4705 or (877) 658 9446 fax (424) 226 1330
