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By Martine G. Brousse
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The major cause for the high cost of cancer treatment often is that of chemotherapy drugs, whether 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 No. 1 expense in an oncology practice.
Solutions are available, but getting approved for financial assistance 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. Know what’s out there
There are three major sources of financial assistance:
- no-cost donations from drug manufacturers: office-dispensed free samples and no-cost 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.
Please note: Medicare and government-issued insurance policy holders are prohibited by law from receiving direct assistance from manufacturers, so apply with private organizations.
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 the National Comprehensive Cancer Network, Medical Oncology Association of Southern California or the Cancer Financial Assistance Coalition.
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 Healthwell and CancerCare. Eligibility guidelines, documentation requirements and application forms can be found online, or by calling the companies’ toll-free numbers.
2. Apply early
You may apply for financial assistance covering your specific diagnosis, specific drugs or both. Many private funds routinely run out of money; it is best to apply between the first and fifth of each month (or ask about a waiting list). Make sure you attach all required documentation with your application. If your financial circumstances have changed this year, add a letter of explanation, as most applications are based on last year’s tax return and income.
Apply, if possible, before your first treatment. If your deductible or out-of-pocket are met before you are approved, you are wasting your time. No grant is retroactive, except for CancerCare (60 days).
3. Separate your diagnoses
You should apply for each diagnosis and/or drug separately. One program is unlikely to cover expenses related to another prescription or condition.
Good examples are 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 Benefits from the insurance carrier 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 a specific dollar amount. Keep track of and renew your application as needed. Don’t assume you will be notified; this is your responsibility, as is notifying all parties of changes.
Because available funds have decreased, and demand has grown, do notify the program when you no longer need your grant money. It can then be disbursed before the year is up or the limit reached. Someone in a needy situation will be grateful!