Medication Assistance 2.0

Often, patients with cancer face having to quit their jobs, apply for disability payments, and deplete their savings, which can lead to bankruptcy.

Financial toxicity to patients battling cancer is well documented within the oncology community. Novel cancer drug therapies are continually released and accrue an increasing number of FDA-approved indications, bringing with them increasingly unaffordable out-of-pocket costs for the patients. At the same time, pharmacy directors are under increasing pressure to reduce their annual drug spend.

The increase in drug costs is not a new phenomenon. However, the cost of individual cancer therapy now frequently exceeds 6 digits. Often, patients with cancer also face having to quit their jobs, apply for disability payments, and deplete their savings, which can lead to bankruptcy. The coronavirus disease 2019 (COVID-19) pandemic has added additional financial distress, with many patients with cancer losing their jobs and employer sponsored health benefits when they can still work. These financial pressures can cause patients to self-discontinue their lifesaving therapies or, at a minimum, leave them grappling with enormous medical debt.

These complex patient circumstances require comprehensive financial navigation services to either optimize patients’ insurance or access more than 10,000 medical financial aid programs that are available, or a combination of both actions. Solving coverage gaps holistically will not only benefit the patient but will also decrease pharmacy drug spend and increase reimbursement and savings for the entire organization.

Financial Navigators

Hospital pharmacy’s conventional use of wholesaler owned patient assistance solutions, which traditionally recover free drugs for uninsured patients only, is outdated and has limited capacity to reach a small subsection of patients in desperate need. A growing number of pharmacies are internalizing these patient assistance processes to include full financial navigation services for the patient, including free drug, co-pay, and foundation assistance. These programs also include screening for Medicaid, the Affordable Care Act plans, Medicare Savings Programs, and Low Income Subsidy.

Financial navigators play an important role in providing guidance and assistance to reduce financial burdens and minimize losses for pharmacies and their organizations. Pharmacy technicians have proved to be ideal candidates for the role of a financial navigator.

Many pharmacy technicians are already acting in the dual role of prior authorization and medication assistance specialists, both of which are fundamental to financial navigation. Nationally certified pharmacy technicians show expertise in intricate job responsibilities, such as compounding chemotherapy, navigating complex insurance issues, and effective communication with patients.

Addressing the Key Health System Pharmacy Challenge

A key challenge to pharmacies internalizing medication assistance and financial navigation efforts is quickly identifying patients in need and determining patients’ eligibility for each specific program. Specialized software and support solutions provide the technology and resources to continuously monitor the more than 10,000 medical financial aid programs that exist, in addition to screening the patient for Medicaid and Medicare Savings Programs eligibility.

Finding the Right Software and Support Solutions Partner

A comprehensive software and support solution should follow the financial navigator’s workflow by screening patients for opportunities to optimize their insurance, in addition to signing patients up for free drug, co-pay, and foundation assistance programs. It should also pull in hospitals’ financial assistance programs, which can help patients cover nonmedication-related expenses, including infusion fees, MRIs and CT scans, labs, and surgeries. It’s also important to find a financial navigation and support solution that offers the following key features:

Automation

Automated systems tap into the vast number of free drug, co-pay, and foundation programs and enroll patients as quickly as possible. Find a system that integrates with electronic health records and match patients with all programs they qualify for based on their diagnoses, treatments, insurance coverages, and financial situations. Automated programs save time and increase efficiency, thereby enabling navigators to extend their reach to more patients in need.

Simple Workflow

To access untapped opportunities, a software solution should employ advanced automation to transform the complex process of program matching and enrollment into a simple workflow that identifies a greater number of coverage opportunities, creating the right financial plan for each patient.

Centralized and Coordinated

The software solution should unify separate financial assistance efforts across departments under a single centralized and coordinated platform, enabling individual departments to collaborate and improve efficiency.

Case Study Results

The FDA’s Oncology Center of Excellence (OCE) implemented a financial navigation software and support solution that could be used by health care teams beyond oncology for a holistic approach to financial assistance automation. In the first 90 days, the OCE increased the amount of financial support by 241% and increased the number of patients receiving financial assistance by 125%.

OCE’s solutions database covers all patient assistance, co-pay, and independent foundation programs, such as the Leukemia & Lymphoma Society, that are specific to patients with cancer and providers. It also includes programs that apply to patients with other chronic conditions, such as multiple sclerosis and Crohn disease, usually treated in the same infusion centers as patients with cancer.

The comprehensiveness of the OCE's software database, streamlined workflow, and reporting functions allow the software solution to support additional financial assistance across the health system.

All necessary information to identify patients in need and determine eligibility and enrollment in a program is maintained within a single system. The financial navigators can complete any of the vast numbers of constantly updated enrollment forms in the system and fax them from within the software. Application status, claims, and medication receipts are tracked end to end.

Financial navigators strategically utilize every source of financial assistance extending beyond free drug, manufacturer, and foundation co-pay assistance programs to ensure that patients with cancer can access lifesaving treatments, while also reducing pharmacy drug spend, and increasing revenue for the organization.

A financial navigator’s work is complex yet of significant value. A software and support solution can streamline their workflow and decrease the time spent on manual processes, such as accessing multiple databases for information to assess the potential financial impact of a patient’s treatment plan. This increased efficiency ensures that no patient is left behind, and no opportunity for financial assistance is missed. This comprehensive approach to financial assistance alleviates patients’ anxiety over the cost of treatment, allowing them to focus on healing and winning the battle against cancer.

When the COVID-19 pandemic ends, many hospitals and health systems will continue to face unprecedented financial pressures. Updating legacy patient medical assistance solutions can help bring financial relief to patients struggling with coverage and extraordinary out-of-pocket expenses, as well as help organizations overcome the financial losses of 2020.

JERILYN ARNESON, PHARMD, BCOP, is a revenue integrity pharmacist.

https://www.pharmacytimes.com/view/medication-assistance-supports-patients-and-pharmacy-alike