Stakeholder Perspective: Practical Considerations in Seeking Financial Assistance for Patients with Cancer

An Interview with Patricia Krueger, RPh, Practice Administrator, Oncology & Hematology Specialists, P.A., Denville, NJ

In today’s competitive and challenging oncology practice environment, savvy practice administrators strive to provide superior customer service to their patients. As part of this effort, administrators and office staff seek to maximize third-party sources of funding to ensure that patients can afford their oncology medications. Many patients require assistance––some are uninsured or underinsured, while others incur significant out-of-pocket costs even if they have health insurance coverage. Practice administrators encounter many challenges in helping their patients locate sources of assistance during the course of their day-to-day responsibilities. Patricia Krueger, RPh, a community-based practice administrator based in Denville, NJ, sat down with<em>Innovations in Oncology Management</em>to discuss some of the practical considerations that practices may encounter when helping patients in need.

Q:Are oncology patients forthcoming about their need for financial assistance? If not, what questions do you ask to uncover their needs?

Patricia Krueger (PK):
Patients are usually forthcoming about their need for assistance after they learn how much they must pay out of pocket. When they come to the office for treatment, they are focused on the battle that they know lies ahead of them in fighting their cancer. It is not usually until after the benefits investigation that they become aware of how much it will cost them to treat their cancer. Few patients are proactive about the cost implications––it’s just not a priority for them.

Practices are aware of this and take control because most patients are unaware of financial support resources, and even if they were aware of the services available to them, they wouldn’t know how to access them. They are very appreciative when the practice takes the time to help them find financial assistance.

Q:In challenging situations, how do you keep office staff motivated to continue seeking financial assistance resources?

Office staff will sometimes “hit the wall” and become frustrated when they are thwarted in their efforts to secure financial assistance. In these situations, the practice administrator may step in and lend his or her experience in order to secure assistance for the patients. To ensure that the office staff is properly trained, the key is education. The more that the office staff is educated about the options available to patients and how to effectively navigate them, the more successful they will be in their efforts.

Q:What are the key differences in applying for manufacturer versus foundation/nonprofit assistance?

PK:Manufacturer programs tend to be more comprehensive in terms of the breadth of offerings they provide, but they are also more complicated and sometimes more challenging to navigate compared with foundation/nonprofit assistance. Of course, many different companies manufacture and market oncology drugs, so there are a large number of programs with different criteria, requirements, and benefits.

The best manufacturer programs are easy to access, allow for electronic enrollment, and have a dedicated representative available to our practice and our patients.

In our experience, foundation programs are more straightforward than manufacturer programs, and foundation programs are typically accessed only for financial assistance. In addition, they are not product-specific like manufacturer programs. As a result, we use a few programs that we have a good comfort level with; for example, Chronic Disease Fund and Patient Access Network Foundation come to mind. In addition, we tend to stick with the programs that we’ve had success with.

Q:How do you keep abreast of new patient support programs or changes to existing programs?

PK:Foundations and nonprofit programs don’t usually change too much, but it can be very difficult to stay abreast of manufacturer programs, which change frequently. We generally rely on industry representatives to keep us informed. If there’s an immediate need, the practice administrator may be proactive in engaging industry representatives to ensure that the office staff is trained. This may happen with a new drug approval, a new indication for an approved drug, or if changes or enhancements have been made to the patient support program.

Q:What are your most important challenges in terms of accessing funding (timing of fund availability, eligibility requirements, etc)?

PK:Manufacturer programs are relatively consistent in terms of funding, which is not necessarily the case with foundations. Some tumor types, such as breast cancer, may have consistent, generous funding available, while others, such as prostate cancer, may be underfunded at times. In cases where funding is scarce, we have to work a little harder to “find the money” for our patients.

There may also be less transparency in terms of eligibility requirements for foundations compared with manufacturer programs. In addition, foundation programs always require documentation of income eligibility, while several manufacturer programs have loosened their level of scrutiny and now conduct periodic audits instead of requiring documentation for each patient. Documentation for financial assistance frequently requires disclosure of gross adjusted income, a term most patients are not familiar with; we often must explain these requirements to our patients.

Q:How does your office coordinate financial support for cancer patients taking a combination of 2 or more expensive drugs? Is it a challenge?

PK:It is a challenge insofar as we must apply separately to different programs if the drugs are marketed by different manufacturers, so it’s twice the amount of work for the office. For patients taking multiple branded drugs, these programs are literally a lifeline, because there is no way they could afford to pay for the out-of-pocket cost of these drugs without assistance. Sometimes this is the case even if the patient has insurance.

Q:Is it a challenge to secure funding for drugs that have been prescribed off-label?

PK:The barriers to coverage and patient assistance may be different for drugs prescribed outside of approved product labeling. Although an oncology drug may be covered by commercial or Medicare payers, even for off-label use, it does not necessarily mean that manufacturer programs and/or foundations will provide financial assistance in these situations.

Q: Do you ever ask oncologists to prescribe a different drug because funding is not available? How receptive are they to these requests?

PK: Yes, there are situations where we ask them to prescribe an alternate therapy if it is therapeutically equivalent or close to equivalent. Most of the time, our oncologists are understanding in these situations.
Q:Do any of your patients require transportation assistance? How do you help them?

PK:Yes, we do have some patients who require transportation assistance. When that happens, the office staff helps to coordinate transportation with local nonprofit services, which are often offered by local hospitals. Some manufacturer programs also help to coordinate transportation assistance for patients in need.

Q:Thank you for taking the time to speak with us today. Do you have any final thoughts to share with your colleagues?

PK:It takes a considerable amount of time and resources to enroll patients in financial assistance programs and provide the necessary documentation, but it is something we are glad to do in order to retain our patients and help them access their oncology medications. Oncology practices should take the time to learn about the range of programs and services available to patients, including eligibility and documentation requirements. Becoming familiar with the details in advance can save time later.

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