The 4th Annual Guide to Patient Support Services a Practical Tool for Oncology Practices

Patient Support Services Guide 2018


The year 2017 witnessed continued innovation in cancer therapies reaching new milestones, with many new cancer treatments entering the market, especially in immunotherapy, with the first ever 2 gene therapies approved by the FDA. Nevertheless, the high costs of oncology drugs can present serious barriers to patients who depend on those therapies. The financial and emotional stresses associated with the high cost of cancer care can be detrimental to the clinical outcomes for patients dealing with a life-threatening disease.

In the current state of the US healthcare system, financial barriers can result from a variety of cases, such as a lack of insurance; inadequate or insufficient insurance coverage; high out-of-pocket expenses, including copays, coinsurance, deductibles, insurance premiums, and the cost of transportation to treatment; legal issues; and loss of employment or loss of work-related benefits. All this can have devastating effects on the physical and psychological health of patients, ultimately compromising their treatment outcomes.

To address these barriers, the majority of pharmaceutical and biopharmaceutical companies today are offering a range of comprehensive patient support services for patients with cancer, including patient education that in some cases are provided by nurses through the drug company, financial assistance with paying for cancer medications or even free medications for those who have no insurance or insufficient income coverage, as well as reimbursement services that help patients and providers with insurance and claim verification, prior authorization issues, and searching for alternative options when reimbursement is not immediately available.

Addressing the barriers to optimal care for patients with cancer, including the financial barriers, is clearly becoming a priority for companies that develop and distribute cancer pharmaceuticals. In addition, several federal programs and nonprofit organizations provide many resources and financial support, including free medications for patients requiring financial assistance, a very common situation when it comes to cancer care. Nevertheless, many providers still avoid the discussion of cost with their patients, and some oncology practices, financial counselors and navigators, and especially patients themselves, are not aware of the existence of these programs. Furthermore, navigating through these support services can be challenging.

To fill this unmet need, and to increase awareness of those services, Oncology Practice Management (OPM) has issued its Fourth Annual Oncology Guide to Patient Support Services. This comprehensive Guide provides an easy-to-use, concise manual for oncology providers to help their patients navigate their cancer treatments, and help those who need financial assistance in paying for those treatments.

This new edition of the Guide provides significant updates on the new programs offered by many pharmaceutical companies; in 2017, many companies made major changes to their support services, and launched new oncology support programs that are easier to navigate and offer extensive services in addition to financial support, including medication education, nurse navigators, and reimbursement managers. This new edition of the OPM Guide offers a quick review of the many new and expanded programs, highlighting an increased awareness on the part of drug companies of the need to ensure access to cancer treatment to all patients, regardless of their type of insurance or income level.

This edition presents new programs issued as of December 1, 2017, and includes individual, unique profiles of support services and programs for new, as well as previously available, cancer drugs offered by all major pharmaceutical companies, highlighting eligibility requirements for financial assistance, eligibility criteria, the application process, and direct contact information for the respective support programs. Feedback from readers and users of the Guide in clinical practice reveals a need for continuing and current updates for this annual Guide.

As Alan Balch, PhD, Chief Executive Officer, Patient Advocate Foundation, says in this Guide, “The key is to screen patients early and often. Tell them what the financial journey will look like for patients with cancer….Regardless of financial status, all patients with cancer need to have some awareness of what scenarios of financial strain they may experience, so that they can plan for them. Commensurate with that, prescreening patients for eligibility in these programs is important. You can’t tell a person, ‘You have cancer’ and then not talk about the likely side effects. You would also say, ‘There are things that we can do to deal with the side effects when they arrive. Let’s monitor those. Let’s be aware that you may experience these side effects.’…The same holds true for financial toxicities. Patients need to be aware of what to expect financially down the road about their treatment, and they should have an opportunity to discuss it and to be prescreened for the types of programs for which they may be eligible.”

Commenting on previous editions of this Guide, Kashyap Patel, MD, Chief Executive Officer and Managing Partner, Carolina Blood and Cancer Care, Rock Hill, SC, and OPM Editorial Board member, finds this Guide “extremely useful, particularly at a time when patient out-of-pocket costs are increasing. This Guide is a comprehensive manual for the office of financial counselors. I haven’t seen any guide as comprehensive as this,” he says.

Dr Patel’s oncology practice offers financial counseling to its patients routinely, and has dedicated financial counselors on staff, who refer to the OPM Guide on a regular basis. “Our financial counselors have a copy of the Guide. When a patient is diagnosed and the treatment plan is designed, we look at the disease fund, or pharma sources, and find out how to optimize these resources to assist the patient,” Dr Patel says. “In the current practice scenario, providing financial counseling is an essential part of the quality requirement that we have to fulfill in order to have a successful oncology care model. This Guide has come in very handy at a time when our practice is transforming to an increasingly patient-centered care facility.”

He further suggests that, “The index for companies helps us to browse through them very quickly. I would definitely strongly recommend the OPM Guide to my oncology colleagues. I am looking forward to the updated Guide this year.”