Perhaps the most significant issue our healthcare system must confront in the face of cost-sharing is that the drugs are still exorbitantly expensive. Third, patient financial assistance programs do nothing to actually lower the price of drugs. Not only does this result in an unequal distribution of assistance, but it may exacerbate financial harm, especially in cases where insurance companies lack the necessary price signals to construct plans to properly account for financial need. Second, not all patients are likely to take advantage of financial assistance, especially in cases where they have lower literacy, or less agency to produce documentation and application materials to qualify for subsidies. 6 In other words, cost reduction today could raise costs tomorrow. This results in insurance providers potentially pricing risk inaccurately in future cases, and creating sub-optimal insurance design. Despite copays or co-insurance, patients who have access to assistance programs are more likely to afford high-priced drugs. Payers may argue that financial assistance programs result in a disruption of market forces 5 since the cost-sharing designs that these insurance companies create cease to matter. Accordingly, in such cases, pharmaceutical companies make substantial profits even after subsidizing patient costs. 5Īlthough the patient is not incurring the full brunt of the costs, we all ultimately pay through higher premiums as payers redistribute costs. 4 However, the remaining cost to insurance was still high. 3 After experiencing public outrage, the company offered $300 subsidies to patients who used the product, which alleviated some burden, and offset the cost enough such that many patients still actively use the drug. A classic example of this phenomenon can be traced back to when Mylan raised the price of its EpiPen by $500 over 8 years. 2 In practice, then, when patients seek financial assistance, pharma indirectly provides them with a discount toward their out-of-pocket expenses. However, many foundations receive a large portion of their funds from the pharmaceutical industry. In some cases, they are indeed run by charitable foundations. 2įirst, it is vital to understand who funds most of these programs. But from a systemic perspective, patient financial assistance programs may be fraught with problems. At first glance, forgiving a portion of the patient’s drug bill may seem like a reasonable solution-certainly, it helps some patients make ends meet while on treatment. One way to avoid undue financial burden is through patient financial assistance programs that subsidize the cost of expensive medicines for patients. This patient-level impact of the cost of cancer care has been referred to as financial toxicity. Even with the existence of mandatory annual out-of-pocket maximums on insurance plans, the financial burden experienced during the course of treatment can result in patients altering their behavior and being non-adherent to treatment. These ever-increasing costs result in higher out-of-pocket costs for patients, which have been shown to worsen outcomes. The price tag of new anticancer drugs has been increasing at a significant pace, with the latest-Kymriah by Novartis-priced at $475,000 per treatment. Guest Post By Rishi Sachdev and Yousuf Zafar, MDĭuke UniversityNew cancer drugs have improved prognoses for patients, but that improvement in effectiveness has come at a steep cost. 2022 State of Survivorship Survey ResultsĪssociate Professor of Medicine and Public Policy,.Cancer Policy and Advocacy Team (CPAT) Virtual Symposium 2022.COVID-19 Resources for Cancer Survivors.Cancer Care Planning and Communications Act (CCPCA).
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