Navigating Through Financial Assistance

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Many patients quickly reach financial toxicity with their co-pays and deductibles, especially when they are on high-cost treatment plans. Well over 50 percent of bankruptcies in the United States are related to high medical costs on behalf of the person filing.

So how do you help your own patients?

As soon as your patient is prescribed a high-cost medication, practices (financial counselors or pharmacy staff) should start the process of looking for financial assistance. But it is important that the person searching understands whether the patient is covered under Medicare or a commercial payer. That information can help you decide between looking for a foundation or using a co-pay card (for those individuals covered under commercial plans).

As most specialty medications need prior authorization (PA), practices will see that patients will need assistance, especially as PA gets denied, causing a delay in treatment. Most foundation assistance is available for brand and generic medications and sometimes for only Medicare Part D patients, as those patients often fall within the income and financial eligibility guidelines.

Commercial patients may continue to need assistance as their deductibles and co-pays may be cost-prohibitive.

If you wait to look for financial assistance until after the PA is approved or denied, foundation assistance may no longer be available.  Foundations open and close regularly – without warning.

Having the patient information on hand will also help if you need to submit for a free drug program – which is received through a mail order pharmacy. Having a patient on a free drug program decreases the amount of interaction your practice and dispensing staff will have with that patient.

The goal is to get the patient to the lowest co-pay.

What are some of the best practices to help patients?

  • One suggestion for practices is to create a spreadsheet to track your specialty patients for refills, foundations, grant amounts and support drugs. Creating this spreadsheet will help you ensure your patients are continuing to receive treatment. As a foundation opens, you can requalify a patient to take those prescription fills back in house.
  • Get to know your drug representatives or field reimbursement managers. They can provide vouchers and samples to help get a patient started on medication as soon as possible. They are also helpful with PAs and denied claims. The reps can also provide patient support kits when available.
  • Keep the patient balances or expiration dates on funding. As assistance starts to run out, you can apply for new assistance to make sure treatment is not interrupted.

Pharmacy Services provides a daily email update which automatically checks on the open and closed foundations for all of the programs – like the Patient Access Network, Cancer Care, National Organization for Rare Disorders (NORD), etc. The email includes a file that can be searched by disease state or drug name. Another file, the Excel document attached in the daily e-mail, includes a tool to help track your patients. To have your practice added to this daily email, contact ashley.placher-biernat@iononline.com.

In October, ION Solutions announced a collaboration with Annexus Health to offer AssistPoint to specialty physician practices. AssistPoint is a cloud-based software platform designed to help physicians seamlessly offer financial assistance to patients after diagnoses and treatment decisions are made. The platform improves provider workflow and management across the administrative patient journey.

Information provided was taken from a webinar titled Navigating Through Financial Assistance in October 2020.