Developing Standards for Managing Financial Toxicity

Financial toxicity is increasingly recognized as an adverse event of modern oncologic treatment. Even the costs of specific agents alone can run $10,000 or more per month, and the out-of-pocket costs for patients can be staggering.

In recognition of the need to guide patients through this aspect of their cancer journey with appropriate tools and services to avoid potentially devastating financial consequences, the Association of Community Cancer Centers (ACCC) has unveiled Financial Advocacy Services Guidelines 2018—a step-by-step protocol for addressing the roles and responsibilities of financial advocacy team members and essential services to include in a suite of patient assistance services.

“Lack of insurance, high co-pays, and high deductibles may result in patients choosing not to seek treatment, to delay treatment, or to abandon treatment altogether,” said Clara Lambert, BBA, OPN-CG, chair of the ACCC Financial Advocacy Network Advisory Committee.

She noted that research has shown that, as the average monthly cost of cancer treatment has more than doubled over the past decade, patients with cancer are twice as likely to file for bankruptcy as those without the disease.

The Financial Advocacy Guidelines, which were distributed to attendees of the ACCC’s 44th Annual Meeting & Cancer Center Business Summit this week in Washington, DC, are designed to support a proactive approach to addressing a patient’s financial needs along the cancer care continuum to ensure access to high-quality care and a better quality of life. The guidelines were developed with the input of financial advocates who routinely work with patients to address these issues, according to the ACCC.

The guidelines recommend that cancer treatment centers have a central financial advocacy system, or a dedicated staff member who works directly with the oncology treatment team to ensure that financial needs are communicated and that access to needed care is facilitated.

Some of the primary goals of financial advocacy services, according to the guidelines, should be to maximize the patient’s health insurance benefits, reduce economic barriers to care, accurately explain coverage and assistance options, manage and track all financial advocacy efforts on behalf of patients, and keep providers and other health team members current on payer policies.

The roles and responsibilities of financial advocacy team members are diverse. Within a practice, financial advocacy efforts may be assigned to navigators, nurses, and pharmacists. The ACCC notes that it is critical that all team members involved with this effort should receive up-to-date training and have a sound skill base.

For this type of work, the ACCC recommends a minimum of a bachelor’s degree or its equivalent in business, life sciences, finance, or a similar field of study. One-to-3 years of experience in financial advocacy with some knowledge of oncology practice are advised.

An advocacy team member should meet with a patient at the time of diagnosis and before the start of treatment to discuss coverage availability and estimated costs of the proposed regimen, along with available patient assistance programs.

Contact with patients should be maintained throughout treatment, and efforts should be made to schedule regular meetings with both patients and family members or caregivers. During those meetings, advocacy team members should be prepared to discuss out-of-pocket amounts, such as co-insurance, deductibles, and co-pays.

Other costs, such as transportation, childcare, and lodging, are also a part of the financial burden that patients may have to carry and should be discussed as well.

Programs are available to assist with costs, and patients should receive help in applying for these funds. Financial advocates should be responsible for tracking the completion of these forms and work throughout the process until funding determinations are made. Payment plan completion is also an essential role of the financial advocacy team member.

There are coverage and patient assistance services that are essential to any well-organized financial advocacy program within a cancer treatment center. These include coverage verification and pre-authorization requests with all third-party payers to minimize disruption to care. Team members should work to ensure that all demographic, coverage, and eligibility information is current.

Another critical role is the documentation of precertification of therapies to ensure that treatment authorizations are accurate and within the targeted date range and quantity of therapy. Patients should be regularly screened for financial toxicity, and team members should stay up-to-date on requirements for enrolling patients in drug manufacturer, state, and local medication assistance programs. They should also be aware of grant programs offered by nonprofit organizations, Medicare prescription benefits, Social Security Low-Income Subsidy, and state and federal assistance subsidies.

Advocacy workers should collaborate with the healthcare team to obtain clinical and financial information for assistance program enrollment. In addition, efforts should be made to coordinate financial assistance efforts with patient eligibility. This includes working as a liaison between the patient and patient assistance programs, according to the ACCC guidelines.

Lambert said that in the past, the role of the financial advocate had been developed piecemeal within cancer treatment centers. “The required skills have been learned on the job with little or no formal training or consistency from program to program.” Unprecedented change in the cancer sector and the US healthcare industry have made it necessary to adopt a much more thorough and organized approach to patient financial advocacy, and many cancer treatment programs offer significantly more sophisticated advocacy programs than in the past. The ACCC’s Financial Advocacy Services Guidelines represent an effort to support and formalize that process.