A novel copay foundation assistance support program for patients receiving cancer therapy in cancer centers

Abstract

6630 Background: With advent of newer CT (biotherapy, chemotherapy, and supportive care) treatment is becoming increasingly expensive for cancer pts. Pts enrolled with Medicare and commercial insurance plans often have large copay requirements with each treatment cycle. Often, these pts undergo significant financial hardship and some pts decline treatment. We have developed a novel support program to coordinate all copay assistance foundations (FDNs) in order to secure financial assistance to facilitate appropriate CT. Methods: In September, 2008 in our multi-site cancer center (11 oncologists, 6 CT sites), we developed a dedicated support program to coordinate pt applications to copay assistance FDNs including Healthwell, Cancer Care, Patient Access, Chronic Disease Fund, Beckstarnd Cancer, Lilly Cares, and Leukemia and Lymphoma Society. Pts requesting assistance with CT copay were enrolled in this program. A dedicated staff individual obtained information about diagnosis, insurance, income level, CT plan and associated co-pay requirements. Data was given to FDNs who determined the amount of monetary assistance. Responses of FNDs and administrative costs were analyzed. Results: Of 264 pts started initiating CT between September 2008 and December 2008, 25 (9.3%) requested assistance for either IV or PO treatments. The average interval between the submission of FDN application and date of determination of assistance was 10 days. Out of 83 applications (3.32 applications/pt), 50 (60%) were approved. Ultimately 22/25 pts received FDN support of $113,475. The most common reasons for denial were if the pt's income exceeded a certain level, exclusion of coverage of certain medications and the FDN being out of funds. The administrative costs associated with this program were $18,000/yr ($720/pt, or $217/application). Administrative costs were 1.64% of approved support. More difficulties were encountered with applications for oral CT than IV CT. Conclusions: Copay for CT drugs is a financial hardship for a significant number of pts. Coordinated resources must be provided and reimbursed to facilitate appropriate and sustainable cancer care. This program is a successful model for other centers. No significant financial relationships to disclose.