Wendi Waugh, BS, RT(R)(T), CMD, CTR, administrative director of cancer services and ambulatory infusion at the Southern Ohio Medical Center Cancer Center in Portsmouth, is a member of the advisory committee for the Association of Community Cancer Centers Financial Advocacy Network. In a discussion with Peers & Perspectives in Oncology, she looked at how the financial burden placed on patients with cancer also becomes a burden for the community center. Here she discussed what community practices can expect regarding a patient’s financial toxicity and the creative solutions available to ease that financial burden.
SIDEBAR
Impact of Financial Toxicity on Cancer Care1
to the National Cancer Institute, the impact of financial toxicity for certain patients with cancer is detrimental to their quality of life and satisfaction with care. Financial toxicity also negatively impacts their caregivers and is associated with poorer medication adherence and survival. Patients who had reported bankruptcy faced an increased risk of mortality compared with those who did not. Moreover, patients aged 18 to 64 years with a cancer diagnosis were more likely to change their prescription drug use due to financial reasons, compared with patients without a history of cancer. Further, the likelihood of nonadherence has been associated with patients who had to have out-of-pocket cost discussions, faced a higher financial burden than expected, or were in high financial distress. Research has shown that patients with cancer who have private insurance had a significant decrease in the risk of their medication nonadherence.
Targeted Oncology: What are some factors that lead to a heavier financial burden during treatment?
WAUGH: There have been some unique challenges since the COVID-19 pandemic where there were high co-pays because there were lots of... different insurance plans [from which] patients could choose…. Some of those plans that they choose have a lower up-front cost [that they could manage] but high deductibles and/ or lots of things that weren’t covered [by the plan]. When you select an insurance plan, as a healthy individual you, of course, don’t expect some catastrophic or major health event to happen. So then, you think, “Oh, it’s a $5000 deductible, but I’ll deal with that when I have to.” They choose this plan because it’s $30 or $100 a month vs $500 a month, not thinking that you’re going to have a $5000 deductible to pay. [With these types of plans there are also] a lot of carve-outs for different medications, including OTC medications. [There are also questions that insurance consumers [don’t consider] at the time, like: do you have prescription coverage with this new insurance? Then, when they become the patient, they understand they don’t have any prescription coverage with this new plan, or that they have a $5000 deductible. [Then they realize they] probably don’t have the means to cover those kinds of things.... We as insurance consumers are not educated enough in what we need to pick for health insurance, so we certainly pick what we think is economical at the time that we’re healthy.
How does a patient’s inability to pay for care affect their treatment, and how does that affect the community practice?
In a hospital-based practice, like [mine], we have some charity care programs, [the] Hospital Care Assurance Program, and discounts that we can do. [However], with the $5000 deductible, we aren’t able to collect that from the patient, so we may collect that at $100 a month over a period [of] months. For the practice, that’s a risk to sustaining the services that you provide.
In our community cancer center, we serve a very high Medicare/Medicaid population, and many of the Medicare patients are on an 80/20 [insurance to out-of-pocket cost] split. So, Medicare will pay 80% of the cost… and then the patient pays 20%... but if that patient hasn’t picked up a supplemental plan, 20% of their health care costs [for treatment of cancer] can be substantial. So again, the practice is at risk of not being able to collect that payment because the patient doesn’t have [the coverage or finances] to collect it from, and then the patient is also worried about these large bills that they will have and wondering whether they can receive the care that they need. [This then leads to them] making decisions about whether they buy groceries today or pay for their medications.
What are some solutions a practice can offer patients?
One of the things that I learned when I joined the [Association of Community Cancer Center Financial Advocacy Network] is that there are patient advocacy networks and financial advocacy network[s] that help patients pay for co-pays, when they qualify.2 A lot of these medications that we prescribe also have medication co-pay cards [that can be applied as well]. We purchased a program called TailorMed that helps us to identify these patients, what their out-of-pocket costs are with their out-of-pocket coverages, and then it helps us to enroll those patients in these co-pay programs.3 It may be co-pay [aid] that helps them with their larger deductible, or we’ll help them with their medication, but it depends on their diagnosis and medications and…also…on their financial status. We’re able to get those co-pays paid for sometimes by these advocacy networks, which is good for the organization because we get paid, and it’s also good for the patient because that co-pay doesn’t come directly from the patient.
A lot of practices have also developed compassion funds that they can dip into to help certain patients with [their financial toxicity]—so, just having a social worker and a financial advocate that the patient can talk to about some of these issues and potentially look at alternative options. [For example, they can help] to find a way to have a hospital bed, that instead of being purchased through DME [durable medical equipment], maybe they can find whether someone’s got one for sale, and our compassion fund might be able to provide that. You must look at innovative and creative ways to get the patient what they need in these cases.
Have you had to find creative solutions for patients at your practice?
One of the things that we’ve done...is develop a pantry. The pantry not only contains food but also sundries, like laundry detergent items that the patient may need [but can’t purchase] during their treatment. If they are identified as having a need, the social worker can meet with them on a regular basis [to identify what they need from us], and we actually bag them up healthy meals [to take] or other items they can take... that would be helpful in maintaining their cleanliness or nutrition during their cancer care. That’s all provided through our compassion fund and we’re pretty proud of it.
What is some advice for community practices?
I would say one of the first steps is, of course, to look into the patient advocacy and financial advocacy network assistance with medication co-pays. No. 2 is to develop an internal charity care program [from which] patients can benefit…. No. 3 is, as an administrator assess your program to find out what kinds of issues and problems…the social workers and financial advocates are having and tell your stories. There are people out there who want to support those stories, but you have got to talk about them first to find out what they are.
REFERENCES
1. Financial toxicity and cancer treatment (PDQ)—health professional version. National Cancer Institute. Updated September 20, 2022. Accessed September 1, 2023. http://tinyurl.com/y65bruzs
2. Quartey A. Financial advocacy strategies to maximize charitable patient assistance. Association of Community Cancer Centers. August 17, 2022. Accessed September 1, 2023. http://tinyurl.com/yv8tze3c
3. TailorMed strengthens nation’s largest network of patients, providers, pharmacies, and life science companies with support from Ballad Ventures, Inception Health, and University Hospitals ventures. News release. TailorMed. December 19, 2022. Accessed September 3, 2023. http://tinyurl. com/a4pfvh7e
