Tips and Resources for Easing the Financial Burden of Cancer Copayments
BY MICHELE MCCOURT, SENIOR DIRECTOR, CCAF
PUBLISHED: FEBRUARY 23, 2016
Cancer is an expensive illness, and even if a patient has a good insurance plan, the cost of cancer treatments can still be a financial burden. Many still face out-of-pocket costs in the form of high premiums, deductibles, copays and coinsurance for their medical and prescription benefits. These costs are compounded by the fact that people with cancer and their caregivers often have to cut back on time spent at work, which means their income decreases at the same time that their bills pile up.
At CancerCare Co-Payment Assistance Foundation (CCAF), we speak with many individuals who face these exact challenges. However, if you are one of the many underinsured Americans seeking assistance paying for cancer treatments, there are steps you can take to help relieve some of your financial burden.
What You Can Do
Know your insurance coverage, and contact your insurance provider with any questions.First and foremost, obtain and read a copy of your insurance policy or summary description of your policy. This will outline your benefits, any coverage limits and the appeals process. Your insurance company can also be a good resource to call if you have questions about what is or is not covered.
Ask your insurance provider to assign you a case manager.A case manager can help you stay organized and navigate your coverage. They may also assist you by letting you know if your health care provider offers a payment plan or if special funding is available.
Communicate with your health care team about costs.Oftentimes, patients do not want to talk with their doctors about paying for treatment. However, talking to your health care team about financial concerns can help ensure that you have access to treatments you need. A financial counselor may be available to you through your provider’s office or cancer center. They will review your treatment plan and insurance coverage to let you know what your cost for treatment may be. They help to identify programs available to reduce costs without reducing the quality of care you receive.
Look into pharmaceutical manufacturer assistance programs.If you are not insured, or have insurance but are not covered by a prescription plan, you may be eligible to receive certain drugs free from the drug company through a patient assistance program. For those who have private insurance, drug manufacturers may provide copay cards to help pay for some medications. Patients insured by Medicare, Medicaid or other federally funded programs are not eligible for these types of programs.
Reach out to nonprofit organizations.These organizations can assist patients in a variety of ways by offering financial assistance for treatment-related expenses, which can include assistance with insurance premiums, copayments for medications and even travel and childcare assistance to help with the additional costs associated with getting to treatment. These organizations have specific eligibility guidelines and are able to assist patients insured through a federal health care program. About 75 percent of the patients assisted by CCAF are insured through a federal health plan like Medicare.
How Oncology Social Workers Can Help
Cancer takes an emotional toll on peopleliving with cancer and their loved ones. Struggling to meet the cost of care adds to this emotional stress. For many people, applying for aid can feel daunting, and it may not be clear who to reach out to for help. An oncology social worker can provide a framework for your experience by offering ways to cope and help initiate a frank discussion about the costs of care and other financial obligations. They can help you navigate government, nonprofit, and pharmaceutical programs, as well as other sources of financial assistance. CCAF is unique because people who reach out to us for support have access to CancerCare’s full array of services, including access to an oncology social worker.
Many people who receive assistance from CCAF say that our help eased an immense financial burden, and allowed them to focus on their diagnosis, treatments and time with loved ones. If you are struggling to afford copayments for cancer medications, we encourage you to reach out.
The CancerCare Co-Payment Assistance Foundation (CCAF) is a nonprofit organization designed to address the financial needs of underinsured cancer patients by assisting with co-payments, coinsurance and premiums that can be a barrier to patients to access their prescribed cancer treatments. To learn more, call 866-55-COPAY (866-552-6729) or visit www.cancercarecopay.org. To learn about CancerCare’s full range of services, visit www.cancercare.org.
SOURCES OF FINANCIAL ASSISTANCE
The financial costs associated with cancer are often overwhelming. Even having health insurance doesn’t guarantee you’ll be able to afford treatment. It’s best to start researching your options before a financial crisis develops. This fact sheet lists various sources of financial assistance available to people with cancer. Check with each agency or organization to see if you qualify for help.
There are a number of federal and state programs that provide financial benefits to individuals and families. These benefits, known as entitlements, are primarily set up for low-income households, the elderly, and the disabled. Each entitlement has eligibility requirements. There are also programs administered through state governments that can help with health care related needs. Government assistance programs include:
U.S. Department of Health & Human Services
Information on public assistance and food stamps. Check phonebook for your local office www.hhs.gov
U.S. Administration on Aging
Benefits for older adults 800-677-1116 www.eldercare.gov
(Eldercare Locator finds resources in your community)
Social Security Administration
Centers for Medicare & Medicaid Services
PHARMACEUTICAL PATIENT ASSISTANCE PROGRAMS
Programs and services offered differ among drug manufacturers but may include:
- Help with insurance reimbursement
- Referrals to co-pay relief programs
- Help with the application process
- Discounted or free medications for patients who do not qualify for other assistance.
Partnership for Prescription for Prescription assistance (PPA)
888-4-PPA-NOW (888-477-2669) www.pparx.org
To see if the drug company that makes your medication has a patient assistance program, check its website. You can also ask your doctor or check with the Partnership for Prescription Assistance (PPA). PPA has a list of pharmaceutical programs and other resources for financial assistance.
NONPROFIT PROGRAMS FOR CO-PAY RELIEF
A number of nonprofit organizations provide help for expenses such as drug co-payments, deductibles, and other medical costs. These programs have their own eligibility rules and may cover only certain cancers. Contact each organization to learn more.
CancerCare Co-Payment Assistance Foundation
Chronic Disease Fund
The Leukemia & Lymphoma Society’s Co-pay Assistance Program
National Organization for Rare Disorders
800-999-6673 (Voice mail only) 203-744-0100 www.rarediseases.org
Patient Access Network Foundation
Patient Advocate Foundation Co-Pay Relief Program
Patient Services Incorporated
In addition to needing help with managing the cost of medicines and treatment, people with cancer often need assistance with expenses like transportation, home care and child care. A number of nonprofit organizations have useful programs or referral information to help with these and other practical needs.
800-813-HOPE (4673) www.cancercare.org
American Cancer Society
The Leukemia & Lymphoma Society
Lymphoma Research Foundation
National Marrow Donor Program
Patient Advocate Foundation’s Colorectal CareLine
Check phonebook under “social service agencies.”
These include Catholic Charities, Lutheran Social Services, Jewish Family Services and others. Check phonebook for listings.
THE CANCER FINANCIAL ASSISTANCE COALITION
The Cancer Financial Assistance Coalition (CFAC) is a group of financial assistance organizations, including CancerCare, that have joined forces to help cancer patients experience better health and well-being by limiting financial challenges. The coalition’s website, www.cancerfac.org, includes a searchable database of local and national organizations that provide financial assistance to people with cancer and their families. The site allows you to search for resources by diagnosis or by the type of financial assistance you need.
CancerCare Can Help
Founded in 1944, CancerCare is the leading national organization providing free support services and information to help people manage the emotional, practical and financial challenges of cancer. Our comprehensive services include counseling and support groups over the phone, online and in-person, educational worskhops, publications and financial and co-payment assistance. All CancerCare services are provided by professional oncology social workers.
To learn more, visit www.cancercare.org or call 800-813-HOPE (4673)
Facebook: facebook.com/cancercare | Twitter: @cancercare
This fact sheet has been made possible by educational donations from : Genentech, a Member of the Roche Group: Lilly: and Amgen.
In order to be eligible for assistance, patients must complete and sign an application and HIPAA Authorization form, as well as provide proof of income. We will review your application and forms on a first-come, first-served basis to the extent that funding is available.
Please note: As a nonprofit organization, we cannot guarantee that funding will always be available for a particular diagnosis. View current covered cancer diagnoses (http://portal.cancercarecopay.org/Funds-Available/Diagnoses). If we are unable to provide co-payment assistance, however, we will refer you to other organizations that may be able to help.
To qualify for assistance, you must meet certain financial, medical and insurance criteria.
- Individuals or families with an adjusted gross income of up to four times the federal poverty level may qualify for assistance.CancerCare Co-Payment Assistance Foundation (CCAF) may also consider the cost of living in your particular city or state.Income verification is required as part of the application process.
- You must have private insurance or Medicare that covers a portion of the prescribed chemotherapy or targeted treatment.
- You must be diagnosed with one of the cancer types that CancerCare Co-Payment Assistance Foundation (http://portal.cancercarecopay.org/Funds-Available/Diagnoses) currently covers. The treating doctor must submit a verification form confirming your diagnosis and medications. Your diagnosis must be verified by a doctor. Your doctor must complete and sign our physician verification form.
- You must currently be undergoing chemotherapy or prescribed and/or using a targeted treatment drug when you apply to CCAF, and at the time of approval.
- You must be covered by private insurance or an employer-sponsored health plan, or you must have Medicare Part B, Medicare Part D or a Medicare Advantage Plan (Medicare C).
Please Note: If you have private insurance, before you contact CCAF, please contact the drug company that manufactures your medication. Drug companies have several programs that may help you.
If you are uninsured (do not have any insurance or medical plan that covers your prescription medicines), you are not eligible for co-payment assistance. However, we encourage you to contact us (http://cancercarecopay.org/contact/) so that we can refer you to other organizations or patient assistance programs.
- You must be receiving treatment in the United States.
- You must be a U.S. citizen or legal resident.
Eligible individuals will receive an application packet with instructions on how to apply for assistance. Our co-payment specialists are available to assist you (http://cancercarecopay.org/contact/) if you have any questions about this process.
We provide easy access to enrollment and can provide same-day approval. To begin the enrollment process, go to our PORTAL (http://portal.cancercarecopay.org/) site.
If we currently do not have funding for your diagnosis, please visit our Resources page (http://cancercarecopay.org/resources/).