Oncology Financial Navigation

Transcription

1 Oncology Financial Navigation Stephanie Boecher MSN - Director of Oncology & Neuroscience Services Rachel Faustner BBA Oncology Financial Navigator Advocate Sherman Hospital Cancer Center Financial Toxicity Definition: is the emotional, mental and physical debilitating and often life-threatening financial side effects induced by cancer treatment. Impact: financial toxicity can lead to the following Greater risk of mortality Impaired qualify of life Overall poorer well-being Sub-par quality of care Source: S. Yousuf Zafar, MD, Journal of National Cancer Institute, Volume 108, Issue 5Snalysis. 1

2 Financial Toxicity Effects on those in active treatment: 130% increase in financial difficulties for those younger than 65 67% increase in financial difficulties for those without insurance 42% increase in financial difficulties for minorities 37% of individuals make at least one work/career modification due to diagnosis 27% of individuals report at least one financial hardship including bankruptcy, debt, etc. Sources: Dana Farber Cancer Institute, 2014 Palliative Care in Oncology Symposium, Oncology Journal, Feb Cancer & Financial Stress Out of pocket expenditures for medical care and related non medical expenses. Loss of earnings for the affected individual Potential reduction in household income related to caregiving needs. Lingering Effects: Chemo Brain or Lymphedema Sources: Fred Hutchinson Cancer Research Center, Financial Toxicity: A Growing Concern Among Cancer Patients in the United States, ISPOR Connections, Vol 20, Number 2. 2

3 Cancers Impact on Financial Stability 40% to 85% of cancer patients stop working at some point during treatment. Individual earnings for cancer survivors tend to fall for a 5 year period after diagnosis which is related to missed opportunities for advancement and ongoing health problems. Many times there is a disruption or loss of insurance coverage in the younger population due to reduction in hours or the need to stop working. Sources: Fred Hutchinson Cancer Research Center, Financial Toxicity: A Growing Concern Among Cancer Patients in the United States, ISPOR Connections, Vol 20, Number 2. Barriers for Cancer Patients Unaware of costs of treatment Patients embarrassed to ask for help 32% of cancer patients report cancer related financial problems 23% of cancer patients reported postponing recommended treatment due to the cost These patients are 2.65 x more likely to go bankrupt than any other diagnosis Unaware of available resources for assistance with treatment Treatment impacts ability for patient to work: o 40-85% stop working during treatment o 1.37 x more likely to be unemployed compared to people without cancer. Source: Kent EE, et al., Are Survivors Who Report Cancer-Related Financial Problems More Likely to Forgo or Delay Medical Care? Cancer, 119, no. 20 (2013): ; A National Poll: Facing Cancer in the Health Care System, American Cancer Society, Ramsey S, et al., Washington State Cancer Patients Found to Be at Greater Risk for Bankruptcy Than People Without a Cancer Diagnosis, Health Affairs, 32, no. 6 (2013): 1-8; Oncology Roundtable interviews and analysis. Source: de Boer AG, Cancer Survivors and Unemployment: A Meta-Analysis and Meta-Regression, Journal of the American Medical Association, 301, no. 7 (2009): ; Oncology Roundtable interviews and analysis. 3

4 Insurance Changes Expansion of Affordable Care Act Health plans switching cost responsibility onto patient Increase in Narrow Networks to drive prices down Coverage for consumers is up Insurance paid for in monthly premiums Monthly premium is affordable, out of pocket costs may not be Patients unaware of what their insurance covers or what responsibility will be Source: Kent EE, et al., Are Survivors Who Report Cancer-Related Financial Problems More Likely to Forgo or Delay Medical Care? Cancer, 119, no. 20 (2013): ; A National Poll: Facing Cancer in the Health Care System, American Cancer Society, Ramsey S, et al., Washington State Cancer Patients Found to Be at Greater Risk for Bankruptcy Than People Without a Cancer Diagnosis, Health Affairs, 32, no. 6 (2013): 1-8; Oncology Roundtable interviews and analysis. Red Flags No Insurance Medicare Only Large out of pocket Medicare Advantage Insured but not working Stage IV diagnosis 4

5 Financial Navigation Goals To provide assistance to patients throughout the continuum of care. Eliminate patients who forgo or postpone treatment due to cost To maximize support from external sources To be proactive with patient concerns vs. reactive Financial Navigation Process Screen all new patients Review Insurance Benefits Options to Mitigate Costs Copay Assistance Programs Free Medication Insurance Optimization Financial Assistance Free Medication Programs Denials Medicare Advantage Vs. Supplemental Plans Social Security Disability Medicaid & Premium Subsidies Cobra vs. ACA Assistance with bills / discounts 10 5

6 Key Components to Drive Navigation Process & Outcomes Diagnosis Treatment Regimen Insurance Annual Household Income Free Medication Programs 11 How to Create a Successful Program Navectis Group (Dan Sherman) 2 year contract Onsite training Personalized reporting sheets 90 min educational session for key stakeholders. Vivor PayRx Navigator Prebuilt search engine Patient specific foundations & copay results. Alerts 12 6

7 Foundations (Copay Assistance) NeedyMeds: PAN Foundation: Patient Advocate Foundation: Health Well Foundation: CancerCare: Leukemia & Lymphoma Society: GoodDays: Johnson & Johnson: Assistance Fund: Patient Assistance - Copay Assistance / Free Medication Genetech BioOncology: Amgen: upport Novartis: Lilly Cares: Pfizer: AstraZeneca (AZ&ME): Abbvie: Merck Helps: Bristol-Myers Squibb: 7

8 Breast Cancer: Herceptin/Perjeta/Carbo/Taxotere/Emend/Aloxi/Sandostatin Case 1: 35 year F / Commercial Genentech BioOncology Copay Card for both Herceptin and Perjeta $25,000 per year with $25 copay. AND PAF Advocate Foundation PAF Breast Fund for both Carbo & Taxotere. AND Novartis Copay Card for Sandostatin. Case 2: 69 year F / Medicare Only Patient Advocate Foundation (PAF) Breast Fund. Covers Copay up to $5,000 per year for Herceptin/Perjeta/Carbo/Taxotere. OR HealthWell Breast Cancer Medicare Access. Covers $15,000 for Herceptin/Perjeta /Carbo/ Taxotere. AND PAN Foundation or HealthWell Foundation Chemo Induced Nausea $1000 in assist for Emend / Aloxi *** NO INSURANCE: Eisai Patient Assistance Program (Aloxi) / Genentech Access to Care Foundation (Herceptin/Perjeta) / Merck Patient Assistance Program (Emend) / Novartis Patient Assistance Foundation (Sandostatin). Non Small Cell Lung Cancer: Opdivo or Keytruda Case 1: 47 year M / Commercial BMS Oncology Co-Pay Card Assistance Program for Opdivo $25,000 per year with $25 copay. Merck Co-Pay Assistance Program For Keytruda $25,000 per year with $25 copay. Case 2: 69 year M / Medicare Only PAN Foundation Non Small Cell Lung Cancer $4800 per year OR HealthWell Non Small Cell Lung Medicare Access $6000 per year OR Patient Advocate Foundation (PAF) Non Small Cell Lung Cancer $6,600 per year *** NO INSURANCE: BMS Patient Assistance Foundation for Opdivo and Merck Patient Assistance Program for Keytruda. 8

9 Neulasta Case 1: 35 year F / Commercial Amgen Neulasta First Step Program - $10,000 per year in Copay Assist with first dose free and $25 copay there after. Case 2: 69 year F / Medicare Only PAN Foundation Neutropenia Fund: $2,300 per year in copay assist for Neulasta. *** NO INSURANCE: Amgen Safety Net Foundation (Neulasta) Patient Examples - Female 74 with Multiple Myeloma / Revlimid & Zometa / Medicare with Supplement & Part D: Has full coverage for Zometa done in Cancer Center. With Medicare Part D needs assistance with Revlimid. From April of 2016 to Feb of 2017 she used $10,046 in funding from PAN Multiple Myeloma Fund. From March of 2017 to Sept 2017 she has used $3360 in funding from the Leukemia and Lymphoma Society. TOTAL FUNDING USED (Patient Savings): $13,406 in 18 months. Female 56 with Lung Cancer / Avastin,Alimta,Neulasta / Medicare Only & Part D: Patient is on Copay Programs for assistance with hospital copays. Healthwell Foundation for Lung Cancer $6800 per year PAN Neutropenia Fund for $2300 per year. TOTAL FUNDING USED (Patient and Hospital Savings): $7,768 in 3 months. Male 71 with Colorectal Cancer / Avastin & Xeloda / Medicare Only: Patient is on Copay Programs for assistance with Oral and Hospital copays. Pan Colorectal Foundation for $9000 (exhausted) CancerCare Colorectal $5000 TOTAL FUNDING USED (Patient and Hospital Savings): $12,701 in 9 months 9

10 2016 Savings: Hospital: $721,033 Patient: $1,618, Savings YTD: Hospital: $779,724 Patient: $959,437 Thank you slide! For the end of every presentation 10