The Gift of Life: Pharmaceutical Companies Helping Patients Afford Their Cancer Medication

Patients who can’t afford their cancer medications may be able to get the drugs for free, or at a reduced cost, from the pharmaceutical companies that make them.

ELIZABETH celebrating her last Herceptin treatment with her healthcare team - PHOTO COURTESY OF GENENTECH

ELIZABETH celebrating her last Herceptin treatment with her healthcare team – PHOTO COURTESY OF GENENTECH

It took less than six weeks for the pea-sized lump in Elizabeth’s breast to grow larger than a golf ball. The biopsy showed stage 3b invasive ductal carcinoma. Luckily, specialists at The Mayo Clinic’s Phoenix campus said that a cutting-edge treatment regimen with two targeted medications could potentially eliminate the cancer. There was just one problem with the plan: Money.

Elizabeth, who asked that her last name be withheld to protect her family’s privacy, had no insurance. Her family’s income and savings were enough to finance therapy solely with the chemotherapy Abraxane (paclitaxel), which cost $1,400 per treatment at Mayo. But when testing at the institution showed her cancer to be HER2-positive, her doctor wanted to supplement the chemotherapy with Herceptin (trastuzumab) and Perjeta (pertuzumab), targeted drugs that can significantly improve survival in this subtype of cancer. That increased the bill to $45,000 per treatment.

The family took out a second mortgage, but even that would not cover the bills. Financial ruin seemed inevitable, until Elizabeth noticed a link on the main page of the Perjeta website.

“It said ‘Financial assistance for those who qualify,’” recalls Elizabeth. “I clicked the link, read the rules and saw that we qualified. I quickly filled out the patient forms. Mayo took a bit longer to fill out the provider forms. The whole thing took about three weeks, and then I got the call from Genentech saying that I was in. The company would cover my Herceptin and Perjeta. I wanted to hug the guy over the phone.”

“It was the most amazing gift,” adds Elizabeth, now a couple of years past her diagnosis. “It makes me teary just thinking about it. We would have lost our house. We would have lost everything if Genentech hadn’t stepped in.”

Genentech isn’t the only pharmaceutical company that runs a prescription assistance program. Nearly all of them provide very expensive medications at little or no cost to qualifying patients who apply for help.

Programs vary considerably from one company to the next, but those that give medications away typically ask applicants to swear that they have little or no prescription drug coverage and then to demonstrate that they have limited financial resources, often through the submission of tax documents. They also must provide documentation proving their legal residence in the U.S.

It is harder to generalize about income thresholds. Some programs use multiples of the federal poverty guideline, which is currently $24,300 for a four-person household. Historically, the most common cutoff has probably been twice the federal guideline, but as treatment costs have risen, income thresholds have often followed. The Lilly Cares Oncology program has a household income threshold of $121,500 for a patient in a family of four with no insurance or insurance that doesn’t cover a prescribed Lilly drug. Other programs, such as the one run by Abbvie, have different maximum incomes for different medications; the more expensive the medication, the greater the maximum income for program participants.

Patients at the other end of the income spectrum — those who are poor enough to qualify for Medicaid or public assistance from their state or city — generally do not qualify for free medication. Pharmaceutical companies typically expect them to take all of the government help they can get and use those programs to finance their medications. They can, however, sometimes qualify for help with any copays those programs ask them to pay.

Indeed, insured patients can often qualify for help with copays, particularly when those copays run to many thousands of dollars per year. Income thresholds are generally lower for partially insured patients than they are for uninsured patients, and they’re generally lower for fully insured patients than for partially insured patients. That said, even well-insured patients who make decent money can sometimes qualify for help.

The moral is simple: If drug costs are putting a serious squeeze on your finances, it pays to see if you qualify for help.

Patients who can show that they meet the insurance, income and residency requirements for pharmaceutical assistance programs will generally need their health care providers to fill out forms designed to show that they qualify medically. In most cases, the relevant documents can be filled out by physicians, nurses or patient advocates, but again, the requirements vary from program to program.

Procedures for filling out such forms also vary from practice to practice. Large oncology practices that treat many underinsured patients often have financial counselors who are experts at securing financial assistance. Good financial counselors will often alert patients that they qualify for assistance rather than waiting for patients to come to them. At other practices, however, a patient will have to print out the relevant forms, request that they be filled out and then keep asking until the practice sends in correctly completed forms.

Even after patients are accepted into a program, they often have to apply for readmission every year or so. Fortunately, the readmission process tends to be simpler than the initial application. In most cases, patients and their doctors only have to affirm that nothing has changed regarding finances, insurance or need for treatment. If something does change, even in the middle of the year, patients are typically obligated to provide immediate notification: Assistance predicated on no insurance stops when you land a job with great insurance.

CURE magazine
By Andrew Smith
November 18, 2016

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