Innovations in Oncology Management

PART 1 OF A SERIES

Support Programs for Patients with Cancer in Need of Financial Assistance

nvestment in cancer research has led to tremendous strides in STAKEHOLDER PERSPECTIVE the improvement of patient care, survival, and quality of life. Although the incidence rates of cancer have not changed Practical Considerations in substantially, cancer death rates have declined 21% among men Seeking Financial Assistance for and 12% among women since the 1990s, and more than 13 milB:8.375” 1 Patients with Cancer ................. 14 lion cancer survivors are alive in the United States today. T:8.125” An Interview with Patricia Krueger, RPh Our ability to map cancer genomes and understand signaling Practice Administrator, Oncology & S:7.625” pathways that govern normal and malignant cell growth have led Hematology Specialists, P.A. to an explosion of knowledge regarding the biochemical changes Denville, NJ that characterize cancer cells. These advances in knowledge have facilitated the development of new and more targeted therapeutic strategies, ushering in an era of increasing potential for personalized medicine.2 it conducted in the private sector, is required to develop breakNew therapies have essentially transformed certain cancers through therapies and technologies in cancer, and it is expensive into chronic diseases, leading to vastly improved long-term sur- to perform the clinical trials required to gain approval and move vival.1 As more patients survive cancer and more individualized new compounds from the bench to the bedside.3,4 treatment is possible, greater attention is being paid to the quality In addition, because most cancers are incurable, patients and the value of healthcare, leading to innovative solutions for cycle through most or all of the possible approved agents, sequality improvement.1 quentially or in combination. As a result, the total treatment Although there have been great advances in cancer diagnostics cost is additive, as new drugs added to the treatment armamenand therapeutics, there is also a considerable cost associated with tarium do not necessarily replace older drugs; rather, they are cancer treatment in general, as well as in the development of new inserted into the treatment pathways as add-ons to former stananticancer therapies. A tremendous amount of research, much of dard-of-care treatments.3,4 Because of these factors, anticancer

Editor’s Note Welcome to Innovations in Oncology Management, a newsletter series for oncology practice administrators, administrative staff, advanced practice clinicians, and oncology pharmacists. The series will provide concise, up-to-date information on current issues that are impacting the business of oncology. Topics will include patient financial support services, health policy legislation, and emerging care delivery and payment models in today’s evolving healthcare landscape. This first issue of the newsletter focuses on the broad array of financial support options that are available to patients in need, including government programs, foundation and nonprofit assistance, and manufacturer programs that are established to help defray some or all of the cost of therapies and other treatment-related expenses. More patients are living with cancer than ever before, and many require ongoing treatment for an extended period of time. As a result, the need for patient support services is greater than ever. We are pleased to provide this valuable resource to help oncology practices better Patients, serve theirScience, patients. and Innovation are the foundation of everything

we do. At Celgene, we believe in an unwavering commitment to medical innovation, from discovery to development. Our passion is relentless—and we are just getting started. Supported by funding from Celgene Corporation and Celgene Patient Support. Manufacturer did not influence content.

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Innovations in Oncology Management

PART 1 OF A SERIES

Support Programs for Patients with Cancer in Need of Financial Assistance

nvestment in cancer research has led to tremendous strides in the improvement of patient care, survival, and quality of life. Although the incidence rates of cancer have not changed substantially, cancer death rates have declined 21% among men and 12% among women since the 1990s, and more than 13 million cancer survivors are alive in the United States today.1 Our ability to map cancer genomes and understand signaling pathways that govern normal and malignant cell growth have led to an explosion of knowledge regarding the biochemical changes that characterize cancer cells. These advances in knowledge have facilitated the development of new and more targeted therapeutic strategies, ushering in an era of increasing potential for personalized medicine.2 New therapies have essentially transformed certain cancers into chronic diseases, leading to vastly improved long-term survival.1 As more patients survive cancer and more individualized treatment is possible, greater attention is being paid to the quality and the value of healthcare, leading to innovative solutions for quality improvement.1 Although there have been great advances in cancer diagnostics and therapeutics, there is also a considerable cost associated with cancer treatment in general, as well as in the development of new anticancer therapies. A tremendous amount of research, much of

STAKEHOLDER PERSPECTIVE Practical Considerations in Seeking Financial Assistance for Patients with Cancer.................. 14

An Interview with Patricia Krueger, RPh Practice Administrator, Oncology & Hematology Specialists, P.A. Denville, NJ

it conducted in the private sector, is required to develop breakthrough therapies and technologies in cancer, and it is expensive to perform the clinical trials required to gain approval and move new compounds from the bench to the bedside.3,4 In addition, because most cancers are incurable, patients cycle through most or all of the possible approved agents, sequentially or in combination. As a result, the total treatment cost is additive, as new drugs added to the treatment armamentarium do not necessarily replace older drugs; rather, they are inserted into the treatment pathways as add-ons to former standard-of-care treatments.3,4 Because of these factors, anticancer

Editorâ&#x20AC;&#x2122;s Note Welcome to Innovations in Oncology ManagementďŁŞ, a newsletter series for oncology practice administrators, administrative staff, advanced practice clinicians, and oncology pharmacists. The series will provide concise, up-to-date information on current issues that are impacting the business of oncology. Topics will include patient financial support services, health policy legislation, and emerging care delivery and payment models in todayâ&#x20AC;&#x2122;s evolving healthcare landscape. This first issue of the newsletter focuses on the broad array of financial support options that are available to patients in need, including government programs, foundation and nonprofit assistance, and manufacturer programs that are established to help defray some or all of the cost of therapies and other treatment-related expenses. More patients are living with cancer than ever before, and many require ongoing treatment for an extended period of time. As a result, the need for patient support services is greater than ever. We are pleased to provide this valuable resource to help oncology practices better serve their patients.

Supported by funding from Celgene Corporation and Celgene Patient Support. Manufacturer did not influence content.

PUBLISHING STAFF Senior Vice President/Group Publisher Nicholas Englezos nenglezos@the-lynx-group.com Vice President/Director of Sales & Marketing Joe Chanley jchanley@the-lynx-group.com Publisher Cristopher Pires cpires@the-lynx-group.com Directors, Client Services Lou Lesperance llesperance@the-lynx-group.com Zach Ceretelle zceretelle@the-lynx-group.com Editorial Directors Dalia Buffery dbuffery@the-lynx-group.com Anne Cooper acooper@the-lynx-group.com Associate Editor Lara J. Lorton Copy Editor Jessica Cheng Editorial Assistant Cara Guglielmon Production Manager Marie RS Borrelli The Lynx Group President/CEO Brian Tyburski Chief Operating Officer Pam Rattananont Ferris Vice President of Finance Andrea Kelly Human Resources Jennine Leale Associate Director, Content Strategy & Development John Welz Director, Quality Control Barbara Marino Quality Control Assistant Theresa Salerno Director, Production & Manufacturing Alaina Pede Director, Creative & Design Robyn Jacobs Creative & Design Assistant Lora LaRocca Director, Digital Media Anthony Romano Web Content Managers David Maldonado Anthony Trevean Digital Programmer Michael Amundsen Meeting & Events Planner Linda Sangenito Senior Project Managers Alyson Bruni Jini Gopalaswamy Project Manager Deanna Martinez Project Coordinator Mike Kodada IT Specialist Carlton Hurdle Executive Administrator Rachael Baranoski Office Coordinator Robert Sorensen Engage Healthcare Communications 1249 South River Road - Ste 202A Cranbury, NJ 08512 phone: 732-992-1880 fax: 732-992-1881

EDITOR'S NOTE Welcome to Innovations in Oncology Management™.............................. 1

FEATURE Support Programs for Patients with Cancer in Need of Financial Assistance........................................................................................ 1 Foundations and Nonprofit Organizations.....................................................................................3

Manufacturer Patient Assistance Programs..................................................................................6 Government Assistance..................................................................................................................12

STAKEHOLDER PERSPECTIVE Practical Considerations in Seeking Financial Assistance for Patients with Cancer An Interview with Patricia Krueger, RPh........................................................... 14

MISSION STATEMENT Oncology healthcare requires providers to focus attention on financial concerns and strategic decisions that affect the bottom line. To continue to provide the high-quality care that patients with cancer deserve, providers must master the ever-changing business of oncology. Innovations in Oncology Management offers process solutions for members of the cancer care team—medical, surgical, and radiation oncologists, as well as executives, administrators, and coders/billers—including patient financial support services, health policy legislation, and emerging payment models.

Innovations in Oncology Management is published by Engage Healthcare Communications, LLC, 1249 South River Road, Suite 202A, Cranbury, NJ 08512. Copyright © 2014 by Engage Healthcare Communications, LLC. All rights reserved. Innovations in Oncology Management is a registered trademark of Engage Healthcare Communications, LLC. No part of this publication may be reproduced or transmitted in any form or by any means now or hereafter known, electronic or mechanical, including photocopy, recording, or any informational storage and retrieval system, without written permission from the publisher. Printed in the United States of America. The ideas and opinions expressed in Innovations in Oncology Management do not necessarily reflect those of the editorial board, the editors, or the publisher. Publication of an advertisement or other product mentioned in Innovations in Oncology Management should not be construed as an endorsement of the product or the manufacturer’s claims. Readers are encouraged to contact the manufacturers about any features or limitations of products mentioned. Neither the editors nor the publisher assume any responsibility for any injury and/ or damage to persons or property arising out of or related to any use of the material mentioned in this publication. POSTMASTER: Correspondence regarding subscriptions or change of address should be directed to CIRCULATION DIRECTOR, Innovations in Oncology Management, 1249 South River Road, Suite 202A, Cranbury, NJ 08512. Fax: 732-992-1881.

To obtain a digital version, download a free QR code app on your SmartPhone and then scan this code.

EHC388-1 2 u OCTOBER 2014

http://innovationsinoncologymanagement.com

therapies can be expensive. According to Express Scriptsâ&#x20AC;&#x2122; 2013 Drug Trend Report, the average cost per prescription for a cancer drug was $4023 in 2013.5 Patients are expected to bear some of the cost of new cancer therapies. However, the affordability of prescription drugs is a concern for many patients, and the ability to afford prescription medications is an important issue in the United States. It is estimated that 40% of Americans of all ages,6 and two-thirds of the elderly population report difficulty paying for medications.7 As a result, more than one-quarter of patients have not filled a prescription or have reduced a prescribed dosage because they cannot afford to pay its out-of-pocket cost.8 Furthermore, despite Medicaid program expansion and the Accountable Care Act mandate requiring eligible individuals to purchase health insurance, many adult Americans remain uninsured.9 Cost-related medication nonadherence has important implications for healthcare, and paradoxically may increase overall health costs, because care that is potentially preventable with the use of effective medications could cost more than the drugs themselves.10-12 Fortunately, there are a number of options for patients with cancer who are in need. This resource intends to provide a broad overview of the patient assistance services that are available to eligible patients with cancer, focusing primarily on programs that help patients afford the cost of prescription drugs. There is no single, central resource for financial assistance services; therefore, patients frequently look to their oncology provider for help in identifying organizations that provide assistance.

Foundations and Nonprofit Organizations

Many foundations and nonprofit organizations are available to help patients in need. Most of these organizations have copayment programs that provide financial assistance for certain healthcare costs to patients who qualify financially and medically. Other organizations serve as resources to help patients identify sources of funding. Specific eligibility requirements and levels of assistance vary widely from program to program; therefore, financial counselors and other oncology administrative staff are urged to research specific program criteria. Below is a list of programs that assist with cancer-related healthÂ care needs. In addition to the contact information listed below, many national organizations can also be contacted through their local affiliates. American Breast Cancer Foundation The American Breast Cancer Foundation provides direct financial assistance to uninsured and underserved women and men of all ages for breast cancer screening and diagnostic tests through the Key to Life Breast Cancer Assistance Program. The program includes annual screenings for women aged >40 years, as well as support services for patients with cancer. Phone: (410) 825-9388; website: www.abcf.org.

American Cancer Society The American Cancer Society has programs and services to help patients with cancer and their loved ones understand cancer, manage their lives through treatment and recovery, and identify resources for patients who need financial assistance. Phone: (800) 227-2345; website: www.cancer.org. American Childhood Cancer Organization The American Childhood Cancer Organization provides programs, information, and awareness for children and adolescents with cancer and their families, to advocate for their needs, and to support research so every child survives and leads a long and healthy life. Phone: (855) 858-2226; website: www.acco.org.

Cost-related medication nonadherence has important implications for healthcare, and paradoxically may increase overall health costs, because care that is potentially preventable with the use of effective medications could cost more than the drugs themselves. Assistance Fund The Assistance Fund is a leading 501(c)(3) nonprofit organization that is established to provide advanced biotech therapies to the underinsured population. Phone: (855) 845-3663; website: www.theassistancefund.org. Avon Foundation for Women The Avon Foundation for Women, through the Avon Breast Health Outreach Program, links medically underserved women to breast health education and screening services. Low-income, underinsured, and other marginalized populations often need targeted, customized approaches to help them obtain regular mammograms and clinical breast exams. Phone: (212) 244-5368; website: www.avonbhop.org. CancerCare CancerCare is a national nonprofit organization that provides free, professional support services to patients with cancer and their caregivers, children, loved ones, and the bereaved. CancerCare programs, which include counseling, education, financial assistance, and practical help, are provided by trained oncology social workers. CancerCareâ&#x20AC;&#x2122;s financial assistance programs provide limited financial assistance for cancer-related costs. Phone: (800) 813-4673; website: www.cancercarecopay.org. Cancer Financial Assistance Coalition The Cancer Financial Assistance Coalition (CFAC) is a group of national organizations that provide financial help to patients INNOVATIONS IN ONCOLOGY MANAGEMENT u 3

with cancer; CFAC provides a searchable database of financial resources available to patients in need. Website: www.cancerfac.org. Cancer Support Community The Cancer Support Community (CSC) is an international nonprofit organization that is dedicated to providing support, education, and hope to individuals affected by cancer. CSC offers a menu of personalized services and education. These support services are available through a network of professionally led, community-based centers, hospitals, community oncology practices, and online resources, so that no one has to face cancer alone. Phone: (888) 793-9355; website: www.cancersupportcommu nity.org.

Many foundations and nonprofit organizations are available to help patients in need. Most of these organizations have copayment programs that provide financial assistance for certain healthcare costs. Chronic Disease Fund The Chronic Disease Fund provides assistance to underinsured patients who are diagnosed with chronic or life-altering diseases (including cancer) that require the use of expensive, specialty therapeutics. Phone: (877) 968-7233; website: www.cdfund.org/Copay-Assis tance.aspx. HealthWell Foundation The HealthWell Foundation is an independent, nonprofit organization that provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums, and deductibles for certain medications and therapies. Phone: (800) 675-8416; website: www.healthwellfoundation.org. Leukemia & Lymphoma Society The Leukemia & Lymphoma Society’s patient financial aid program provides limited financial assistance to patients diagnosed with a blood cancer (eg, leukemia, lymphoma, or multiple myeloma) and with significant financial needs to help defray treatment-related expenses. Phone: (800) 955-4572; website: www.lls.org/copay. National Children’s Cancer Society The National Children’s Cancer Society seeks to improve the quality of life for children with cancer and their families by providing financial and in-kind assistance, advocacy, support services, and education. Phone: (800) 532-6459; website: www.thenccs.org. 4 u OCTOBER 2014

National Foundation for Transplants The National Foundation for Transplants provides fundraising assistance for patients needing transplants, including bone-marrow and stem-cell transplants. Phone: (800) 489-3863; website: www.transplants.org. National Organization for Rare Disorders The National Organization for Rare Disorders (NORD) is a federation of voluntary health organizations that are dedicated to helping patients with rare orphan diseases and assisting the organizations that serve them. NORD is committed to the identification, treatment, and cure of rare disorders through programs of education, advocacy, research, and service. Phone: (203) 744-0100; website: www.rarediseases.org. NeedyMeds NeedyMeds is a 501(c)(3) nonprofit organization that helps individuals who cannot afford medications or other healthcare costs. NeedyMeds is an information source on companies that offer patient assistance programs. These programs help patients obtain medications at no cost or low cost through the manufacturer. Phone: (800) 503-6897; website: www.needymeds.org. Partnership for Prescription Assistance The Partnership for Prescription Assistance helps qualifying patients without prescription drug coverage get the medication they need for free or nearly free. This organization offers access to more than 475 public and private programs, including 200 pharmaceutical company programs. Phone: (888) 477-2669; website: www.pparx.org. Patient Access Network Foundation The Patient Access Network Foundation provides financial support for out-of-pocket costs associated with a wide range of medications to treat a number of conditions, including cancer. Phone: (866) 316-7263; website: www.panfoundation.org. Patient Advocate Foundation Copay Relief Program The Patient Advocate Foundation Copay Relief Program currently provides direct financial support to insured patients, including Medicare Part D beneficiaries, who must financially and medically qualify to access pharmaceutical copayment assistance. Phone: (866) 512-3861; website: www.copays.org. Patient Services, Inc Patient Services, Inc is a nonprofit organization dedicated to providing health insurance premium assistance, pharmacy copayment assistance, and copayment waiver assistance for patients with specific expensive chronic illnesses. Phone: (800) 366-7741; website: www.patientservicesinc.org. RxHope RxHope helps patients obtain free or low-cost prescription medications. RxHope has program descriptions and downloadhttp://innovationsinoncologymanagement.com

Christine Celgene Patient Support ® Specialist

Your single source for personal support

Celgene Patient Support® offers you and your patients financial assistance and insurance-related services from a single Specialist assigned to your area. Co-pays for Celgene medications are reduced to $25 or less for eligible patients. Celgene Commercial Co-pay Programa

Financial assistance through third-party organizations

Celgene Free Medication Programa

Help with locating transportation assistance

Call Celgene Patient Support® at 1-800-931-8691 Monday – Friday, 8 AM – 7 PM ET

Online enrollment now available at www.celgenepatientsupport.com Or e-mail us: patientsupport@celgene.com a

Subject to eligibility requirements.

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able applications for prescription assistance programs for specific medications. Phone: (877) 267-0517; website: www.rxhope.com. RxAssist Using their online Patient Assistance Program Center, RxAssist helps patients find information about free and low-cost medicine programs, as well as other ways to manage their medication costs. Website: www.rxassist.org. Note: The author conducted a thorough search to identify leading oncology-related foundations and nonprofit organizations; however, this is not intended to be a fully comprehensive list.

Manufacturer Patient Assistance Programs

Many pharmaceutical companies offer financial assistance to help individuals defray the cost of their medications. These programs serve as a safety net for Americans who are not eligible for comprehensive assistance programs and cannot afford their medications. Most programs require proof of financial status to establish eligibility. Below is a list of manufacturer patient assistance programs that offer financial support to eligible patients for anticancer therapies and supportive-care agents.

Many pharmaceutical companies offer financial assistance to help individuals defray the cost of their medications. AbbVie

AbbVie Patient Assistance Foundation The AbbVie Patient Assistance Foundation provides AbbVie medications at no cost to patients experiencing financial difficulty who may or may not have or qualify for prescription medication benefits through private insurance or government-funded programs. Phone: (800) 222-6885; website: www.abbviepaf.org. • Lupron Depot (leuprolide acetate) for depot suspension • Lupaneta Pack (leuprolide acetate and norethindrone acetate)

Amgen Inc

Commercial Copay Assistance Coupon Support Amgen Inc offers copay coupon programs to help commercially insured, eligible patients with their deductible, coinsurance, and/or copayment requirements. Phone: (888) 657-8371; website: www.amgenfirststep.com. • Neulasta (pegfilgrastim) • Nplate (romiplostim) 6 u OCTOBER 2014

• Prolia (denosumab) • Xgeva (denosumab) Safety Net Foundation The Safety Net Foundation is a nonprofit patient assistance program designed to assist patients who are uninsured, with limited or no financial resources. Program eligibility is based on US residency, insurance status, and income requirements. Phone: (888) 762-6436; website: www.safetynetfoundation.com. • Aranesp (darbepoetin alfa) • Epogen (epoetin alfa) • Neulasta (pegfilgrastim) • Neupogen (filgrastim) • Nplate (romiplostim) • Prolia (denosumab) • Sensipar (cinacalcet) • Vectibix (panitumumab) • Xgeva (denosumab)

ARIAD Pharmaceuticals, Inc

ARIAD PASS The ARIAD PASS (Patient Access and Support Services) program helps providers and their eligible patients afford treatment. Phone: (855) 447-7277; website: www.ariadpass.com. • Iclusig (ponatinib)

Astellas Pharma US, Inc

Xtandi Patient Savings Program This program is intended for patients who have commercial and/or private health insurance, but who may have trouble paying their medication out-of-pocket costs. Phone: (855) 898-2634; website: www.astellasaccess.com. • Xtandi (enzalutamide) Astellas Access Program This program is designed for patients who have no health insurance. The program provides free Xtandi to patients who qualify for enrollment based on their insurance status and household income. Phone: (855) 982-6341; website: www.astellasaccess.com. • Xtandi (enzalutamide)

AstraZeneca

AZ&Me Prescription Savings Program The AZ&Me Prescription Savings Program provides Astra Zeneca medications at no cost to individiuals without health insurance and to Medicare Part D beneficiaries. This program provides AstraZeneca medications to low-income patients through qualifying facilities, such as disproportionate share hospitals, community health centers, community free clinics, central-fill pharmacies, and charitable pharmacies. Phone: (800) 292-6363; website: www.astrazeneca-us.com/ medicines/help-affording-your-medicines/azandme-prescriptionsavings-programs. • Arimidex (anastrozole) • Faslodex (fulvestrant) http://innovationsinoncologymanagement.com

• Zoladex (goserelin acetate) implant • Caprelsa (vandetanib)

Bayer HealthCare Pharmaceuticals, Inc

Resources for Expert Assistance and Care Helpline This program is designed to reduce the monthly copays of patients with private insurance. Phone: (866) 639-2827; website: www.patientassistance.com/ profile/bayerhealthcarepharmaceuticals-275. • Nexavar (sorafenib) • Stivarga (regorafenib) Xofigo Access Services Xofigo Access Services provides Xofigo (radium Ra 223 dichloride) free of charge to eligible patients who are uninsured or who are insured but do not have coverage for Xofigo. Patients with private commercial insurance may also be eligible for copay assistance. Phone: (855) 696-3446; website: www.xofigo-us.com/hcp/pa tient-support. • Xofigo (radium Ra 223 dichloride)

Bristol-Myers Squibb

Bristol-Myers Squibb Patient Assistance Foundation This foundation assists patients who need temporary help paying for the medications listed below. To receive temporary help, patients must prove financial hardship and meet other eligibility criteria. Phone: (800) 736-0003; website: www.bmspaf.org/Pages/Home. aspx. • Erbitux (cetuximab) • Ixempra (ixabepilone) • Sprycel (dasatinib) • Yervoy (ipilimumab) Bristol-Myers Squibb Oncology Copay Program This program is designed to assist with out-of-pocket copays or coinsurance requirements for eligible, commercially insured patients prescribed the below Bristol-Myers Squibb medications, per US Food and Drug Administration (FDA)-approved indications. Phone: (800) 861-0048; website: www.bmsaccesssupport.com/ contact.aspx. • Droxia (hydroxyurea) • Etopophos (etoposide phosphate) • Lysodren (mitotane) • Erbitux (cetuximab) • Ixempra (ixabepilone) • Sprycel (dasatinib) • Yervoy (ipilimumab)

Celgene Corporation

Celgene Patient Support Celgene Patient Support offers healthcare professionals and patients access and reimbursement assistance from a single specialist assigned to each doctor's office. No matter what the insur-

ance situation, Celgene Patient Support is committed to helping patients access their Celgene medication. Phone: (800) 931-8691; website: www.celgenepatientsupport. com. Celgene Commercial Co-Pay Program This program provides up to $10,000 annually to help meet deductible and copay/coinsurance costs. For qualified patients in the program, their cost will be $25 or less, depending on which Celgene drug they are prescribed (assistance not to exceed $10,000). To qualify, patients must have commercial/private insurance and a household income of $100,000 or less. Phone: (800) 931-8691; website: www.celgenepatientsupport. com. • Abraxane (paclitaxel protein-bound particles for injectible suspension) (albumin bound) • Pomalyst (pomalidomide) • Revlimid (lenalidomide) • Thalomid (thalidomide) Free Medication Program Patients who do not have insurance coverage for a Celgene medication prescribed by their physicians may be eligible for this program. Patients must meet financial criteria to be eligible for assistance. Program eligibility is based on household income and assets. Phone: (800) 931-8691; website: www.celgenepatientsupport. com/free_medication_program.aspx. • Abraxane (paclitaxel protein-bound particles for injectible suspension) (albumin bound) • Istodax (romidepsin) for injection • Pomalyst (pomalidomide) • Revlimid (lenalidomide) • Thalomid (thalidomide) • Vidaza (azacitidine)

These programs serve as a safety net for Americans who are not eligible for comprehensive assistance programs and cannot afford their medications. Covis Pharmaceuticals, Inc

Covis Patient Assistance Program The Covis Patient Assistance Program helps US citizens or residents who do not have a healthcare plan or have been denied coverage for treatment. Phone: (877) 438-9759; website: www.covispharma.com/pa tient_assistance.html. • Nilandron (nilutamide) INNOVATIONS IN ONCOLOGY MANAGEMENT u 7

DARA BioSciences, Inc

No Coupon, No Copay, No Hassles Program This program is intended to reduce or eliminate financial outlays by offsetting patient out-of-pocket copay expenses, and will be applied automatically to qualified prescriptions at more than 43,000 pharmacies nationwide. Additional paperwork, coupons, or electronic input is not required by patients, healthcare providers, or pharmacists. Phone: (919) 872-5578; website: www.darabio.com. • Gelclair (bioadherent oral rinse gel) • Soltamox (tamoxifen citrate)

Dendreon Corporation

Provenge Patient Assistance Program Dendreon is committed to helping patients who are eligible for treatment gain access to patient assistance through the Provenge Patient Assistance Program. Patients may be eligible to access PROvide––the Provenge (sipuleucel-T) commercial copay program that provides financial assistance for copays, coinsurance, and deductible costs. For eligible patients who do not have coverage for Provenge, Dendreon provides Provenge free of charge. Phone: (877) 336-3736; website: www.provengereimbursement.com/ patient-assistance.aspx. • Provenge (sipuleucel-T)

them. Patients must meet financial and other program-specific criteria to be eligible for assistance. Phone: (800) 462-3636; website: www.endo.com/endopharma/ about-us/u-s-patient-assistance. • Valstar (valrubicin) • Vantas (histrelin) implant

Genentech, Inc

Genentech Access to Care Foundation The Genentech Access to Care Foundation helps patients receive medications for free if they do not have a healthcare plan or have been denied coverage for treatment. Patients must have a household-adjusted income of $100,000 or less annually. Phone: (888) 249-4918; website: www.genentech-access.com. • Avastin (bevacizumab) • Erivedge (vismodegib) • Gazyva (obinutuzumab) • Herceptin (trastuzumab) • Perjeta (pertuzumab) • Rituxan (rituximab) • Tarceva (erlotinib) • Xeloda (capecitabine) • Zelboraf (vemurafenib) Genentech BioOncology Copay Card The BioOncology Copay Card helps qualified patients with their out-of-pocket prescription costs. Eligible patients must be aged ≥18 years and must be covered by commercial insurance. Phone: (855) 692-6729; www.genentech-access.com. • Avastin (bevacizumab) • Erivedge (vismodegib) • Gazyva (obinutuzumab) • Herceptin (trastuzumab) • Perjeta (pertuzumab) • Rituxan (rituximab) • Tarceva (erlotinib) • Xeloda (capecitabine) • Zelboraf (vemurafenib)

Gilead Sciences, Inc Eisai Inc

Eisai Oncology Patient Assistance Program The Eisai Oncology Patient Assistance Program provides medications free of charge to US residents who lack access to prescription drug coverage and meet specific financial criteria. Phone: (866) 613-4724; website: www.eisaipatientassistance.com. • Aloxi (palonosetron hydrochloride) injection • Halaven (eribulin mesylate) injection

Endo Pharmaceuticals Inc

Endo Patient Assistance Program The Endo Pharmaceuticals Inc patient assistance program offers free medications to patients who otherwise cannot afford 8 u OCTOBER 2014

Zydelig AccessConnect The Zydelig AccessConnect program provides Zydelig (idelalisib) at no charge to eligible patients with no other insurance options. Phone: (844) 622-2377; website: www.gilead.com/responsibility/us-patient-access/zydelig. • Zydelig (idelalisib) Zydelig Copay Coupon Program The Zydelig Copay Coupon Program provides copay assistance for eligible patients with private insurance who need assistance paying for their out-of-pocket medication costs. Most patients will pay no more than $5 per monthly copay. Phone: (844) 622-2377; website: www.activatethecard.com/ zydelig. • Zydelig (idelalisib) http://innovationsinoncologymanagement.com

GlaxoSmithKline

Commitment to Access Program GlaxoSmithKline (GSK)’s patient assistance program supports access to GSK’s oncology and certain specialty pharmacy drugs at little or no cost to qualified patients. Phone: (866) 265-6491; website: www.gskcta.com. • Arranon (nelarabine) • Arzerra (ofatumumab) • Bexxar (tositumomab) • Hycamtin (topotecan) capsules • Hycamtin (topotecan hydrochloride) for injection • Leukeran (chlorambucil) • Mekinist (trametinib) • Myleran (busulfan) • Promacta (eltrombopag) • Tafinlar (dabrafenib) • Tykerb (lapatinib) • Votrient (pazopanib) • Zofran (ondansetron hydrochloride) Copay Assistance Program The GSK Copay Assistance Program is available to those individuals with commercial prescription coverage who satisfy income and other eligibility requirements. Phone: (866) 265-6491; website: www.gsk-access.com. • Arranon (nelarabine) • Arzerra (ofatumumab) • Bexxar (tositumomab) • Hycamtin (topotecan) capsules • Hycamtin (topotecan hydrochloride) for injection • Leukeran (chlorambucil) • Mekinist (trametinib) • Myleran (busulfan) • Promacta (eltrombopag) • Tafinlar (dabrafenib) • Tykerb (lapatinib) • Votrient (pazopanib) • Zofran (ondansetron hydrochloride)

Incyte Corporation

IncyteCARES Patient Assistance Program The IncyteCARES (Connecting to Access, Reimbursement, Education, and Support) Patient Assistance Program helps individuals who do not have a healthcare plan. The program can also help patients whose plans have turned them down for Jakafi (ruxolitinib) treatment. Patients with private or commercial prescription insurance may be eligible to receive Jakafi for no more than $50 monthly, depending on their income. Phone: (855) 452-5234; website: www.jakafi.com/incytecares.com. • Jakafi (ruxolitinib)

Janssen

Janssen Prescription Assistance Janssen Prescription Assistance provides financial help to indi-

viduals who have difficulty affording their medications. Phone: (800) 526-7736; website: www.janssenprescriptionassis tance.com. • Doxil (doxorubicin hydrochloride liposome) injection • Procrit (epoetin alfa) • Sylvant (siltuximab) • Zytiga (abiraterone acetate)

Most programs require proof of financial status to establish eligibility. Johnson & Johnson

Johnson & Johnson Patient Assistance Foundation, Inc The Johnson & Johnson Patient Assistance Foundation, Inc assists patients without adequate financial resources and prescription drug coverage in obtaining free medications donated by the operating companies of Johnson & Johnson. There is 1 application for all agents, and patients may receive free medicines for up to 1 year. Phone: (800) 652-6227; website: www.jjpaf.org/index.html.

Lilly USA, LLC

PatientOne PatientOne addresses financial and coverage issues for qualified uninsured, underinsured, and insured patients who are prescribed a Lilly oncology drug. PatientOne can help provide replacement vials for ongoing therapy to qualified uninsured patients who earn up to 500% of the federal poverty level. In addition, PatientOne provides assistance to insured patients whose claims for a Lilly oncology drug have been denied by their insurer. Certain eligibility requirements apply. Approved drug requests are conveniently shipped to the physician’s office. Phone: (866) 472-8663; website: www.lillypatientone.com. • Alimta (pemetrexed) • Erbitux (cetuximab); comarketed with Bristol-Myers Squibb • Gemzar (gemcitabine hydrochloride) • Cyramza (ramucirumab injection)

Merck and Co, Inc

ACT Program The ACT Program provides free reimbursement support services to help answer questions related to insurance coverage and reimbursement. The ACT Program also refers patients to the patient assistance program, which provides certain Merck medicines free of charge to eligible patients who do not have insurance coverage. Many Merck medications are included in this program. Phone: (866) 363-6379; website: www.merck.com/merckhelps. Merck Copay Assistance Program The Merck Copay Assistance Program is available to eligible, INNOVATIONS IN ONCOLOGY MANAGEMENT u 9

privately insured patients who may need help affording their copay on certain Merck oncology drugs. Phone: (855) 263-1774; website: www.merck.com/merckhelps. • Emend (aprepitant) • Emend (fosaprepitant dimeglumine) for injection • Intron A (interferon alfa-2b, recombinant) for injection • Sylatron (peginterferon alfa-2b) for injection • Temodar (temozolomide) • Temodar (temozolomide) for injection • Zolinza (vorinostat)

Millennium Pharmaceuticals, Inc

Velcade Patient Assistance Program Patients without insurance coverage for Velcade (bortezomib) may be eligible to participate in the Velcade Patient Assistance Program. For qualifying patients, Velcade will be delivered free of charge to the treating physician. The Velcade Patient Assistance Program will reimburse up to a 12-month supply of Velcade if enrolled patients lose their insurance and continue to receive care. Drug replacement may be available for eligible patients who have been denied insurance coverage. Phone: (866) 835-2233; website: www.velcade-hcp.com/reim bursement. • Velcade (bortezomib)

• • • •

Sandostatin (octreotide acetate) for injection Tasigna (nilotinib) tablets Zometa (zoledronic acid) injection Zykadia (ceritinib)

Patient Assistance NOW Oncology Program The Novartis Patient Assistance NOW Oncology program offers quick and easy access to information about the many reimbursement and support programs available to patients. Patients with private insurance or without prescription coverage may be eligible to receive copay discount cards on certain medications. Phone: (800) 282-7630; website: www.oncologyaccessnow.com. • Afinitor (everolimus) tablets • Exjade (deferasirox) • Gleevec (imatinib mesylate) tablets • Sandostatin LAR Depot (octreotide acetate) for injectable suspension • Sandostatin (octreotide acetate) for injection • Tasigna (nilotinib) tablets • Zometa (zoledronic acid) injection • Zykadia (ceritinib)

Onyx Pharmaceuticals

Onyx 360 This comprehensive, personalized program is designed to support providers and patients (who meet certain eligibility criteria) with free medication assistance for uninsured patients or those rendered uninsured through payer denial. Phone: (855) 669-9360; website: www.onyx.com/therapies/pa tient-access/onyx-360. • Kyprolis (carfilzomib) for injection • Nexavar (sorafenib) tablets

Pfizer, Inc

Novartis Pharmaceuticals Corporation

Novartis Oncology Patient Assistance Foundation, Inc The Novartis Oncology Patient Assistance Foundation, Inc provides assistance to patients who experience financial hardship and who have no third-party insurance coverage for their medications. Phone: (800) 277-2254; website: www.patientassistancenow.com. • Afinitor (everolimus) tablets • Exjade (deferasirox) • Femara (letrozole) tablets • Gleevec (imatinib mesylate) tablets • Sandostatin LAR Depot (octreotide acetate) for injectable suspension 10 u OCTOBER 2014

RxPathways Pfizer RxPathways may help patients without insurance coverage get their Pfizer medications for free. If patients meet eligibility requirements, RxPathways can also provide copay assistance to patients who have prescription coverage, but cannot afford their coinsurance or have been denied coverage. Phone: (866) 706-2400; website: www.pfizerrxpathways.com/?step=1. • Aromasin (exemestane) tablets • Bosulif (bosutinib) tablets • Camptosar (irinotecan hydrochloride) injection • Ellence (epirubicin hydrochloride) injection • Emcyt (estramustine phosphate sodium) capsules • Idamycin (idarubicin hydrochloride) for injection, USP • Inlyta (axitinib) tablets • Neumega (oprelvekin) • Sutent (sunitinib malate) • Torisel (temsirolimus) injection • Xalkori (crizotinib) capsules • Zinecard (dexrazoxane) for injection http://innovationsinoncologymanagement.com

Pharmacyclics

Imbruvica YOU&i Support Program Patients with commercial insurance and who meet certain eligibility requirements pay no more than $10 monthly for Imbruvica (ibrutinib). Eligible patients prescribed Imbruvica for an FDAapproved indication, and who are experiencing an insurance coverage delay greater than 5 business days, can receive a free, 30-day supply of Imbruvica. Under appropriate circumstances, an additional free, 30-day supply of Imbruvica may be provided. Phone: (877) 877-3536; website: www.imbruvica.com/youandi. • Imbruvica (ibrutinib)

Prometheus

Prometheus IV Bolus Proleukin Inpatient Reimbursement Hotline As part of their commitment to ensure that all eligible patients have access to Proleukin (aldesleukin), the Prometheus IV Bolus Proleukin Inpatient Reimbursement Hotline is staffed with specialists who can help resolve specific access and reimbursement issues for patients and physicians. Phone: (877) 776-5385; website: www.proleukin.com/healthcare-professional/resources/. • Proleukin (aldesleukin)

Phone: (855) 473-2436; website: www.seagensecure.com. • Adcetris (brentuximab vedotin)

Sigma-Tau Pharmaceuticals, Inc

SOS Copay Assistance Program Sigma-Tau Pharmaceuticals, Inc is offering the SOS (Sigma-Tau Outreach Services) Copay Assistance program for patients taking Oncaspar (pegaspargase) to reduce the out-of-pocket costs of Oncaspar. Eligible patients who enroll in this program may obtain copay assistance through the electronic benefit cards or checks. Phone: (855) 497-3366; website: www.sigmatau.com/support/ support_oncaspar.asp. • Oncaspar (pegaspargase)

ProStrakan

Patient Rx Solutions Patient Rx Solutions is designed to assist uninsured individuals and those who have no public or private prescription coverage. ProStrakan also offers copay assistance to eligible individuals with private insurance. Phone: (866) 676-5884; website: www.patientrxsolutions.com • Fareston (toremifene citrate) • Sancuso (granisetron transdermal system)

Spectrum Pharmaceuticals, Inc

Sanofi Patient Connection Through the Sanofi Foundation of North America, Sanofi Patient Connection provides medications free of charge to patients who have no insurance coverage or who are considered to be functionally uninsured. Phone: (888) 847-4877; website: www.visitspconline.com. • Elitek (rasburicase) • Eloxatin (oxaliplatin) • Jevtana (cabazitaxel) • Leukine (sargramostim) • Mozobil (plerixafor) • Taxotere (docetaxel) for injection • Thymoglobulin (antithymocyte globulin [rabbit]) • Zaltrap (ziv-aflibercept)

STAR Spectrum Pharmaceuticals, Inc is committed to providing appropriate patient access to care. STAR (Spectrum Therapy Access Resources) includes a copay assistance program to assist privately insured patients (who meet the STAR eligibility criteria) with copay and coinsurance responsibilities related to certain Spectrum medications. In addition, the STAR program includes a patient assistance program that provides Spectrum medications free of charge to enrolled patients who meet the income, insurance, and citizenship/residency eligibility criteria. Phone: (888) 537-8277; website: www.getasapinfo.com. • Folotyn (pralatrexate) injection • Fusilev (levoleucovorin) • Marqibo (vincristine sulfate liposome) injection • Zevalin (ibritumomab tiuxetan)

Seattle Genetics

Teva Oncology

Sanofi Oncology

SeaGen Secure Patient Assistance Program SeaGen Secure is a comprehensive assistance program for uninsured and underinsured patients who have been prescribed Adcetris (brentuximab vedotin).

Comprehensive Oncology Reimbursement Expertise Comprehensive Oncology Reimbursement Expertise supports patients and providers through programs for eligible patients treated in the United States who do not have insurance, cannot INNOVATIONS IN ONCOLOGY MANAGEMENT u 11

afford their out-of-pocket copay costs, or need assistance with reimbursement issues. Phone: (888) 587-3263; website: www.tevacore.com. Note: The author conducted a thorough search to identify leading oncology-related manufacturer patient assistance programs; however, this is not intended to be a fully comprehensive list.

Government Assistance

There are a number of government programs that provide assistance and resources to individuals and families. These benefits are primarily set up for low-income households, the elderly, and the disabled. Each program has specific eligibility requirements. There are also programs administered through state governments that can help with healthcare-related needs. Government assistance programs include:

There are a number of government programs that provide assistance and resources to individuals and families. These benefits are primarily set up for low-income households, the elderly, and the disabled. BenefitsCheckUp (National Council on Aging) BenefitsCheckUp helps individuals aged â&#x2030;Ľ55 years find programs that may cover some of their prescription drug costs, healthcare expenses, and other services. Phone: (202) 479-1200; website: www.benefitscheckup.org. Compassionate Allowances (Social Security Administration) Compassionate Allowances are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate Allowances allow Social Security to quickly target the most obviously disabled individuals for allowances. Phone: (800) 772-1213; website: www.ssa.gov/compassionate allowances/. Extra Help (Social Security Administration) Medicare beneficiaries may qualify for Extra Help with their Medicare prescription drug plan costs. Extra Help is estimated to be worth about $4000 annually. To qualify for Extra Help, an individual must receive Medicare, have limited resources and income, and reside in 1 of the 50 states or in the District of Columbia. Phone: (800) 772-1213; website: www.ssa.gov/medicare/prescrip tionhelp/. 12 u OCTOBER 2014

Hill-Burton Free and Reduced-Cost Healthcare (Health Resources and Services Administration) More than 160 healthcare facilities nationwide provide free or reduced-cost care as mandated by the Hill-Burton Act. Patients are eligible to apply for Hill-Burton free care if their income is at or below the current Health & Human Services Poverty Guidelines. Phone: (800) 638-0742; website: www.hrsa.gov/gethealthcare/ affordable/hillburton/. Patient Travel and Lodging Program (Office of Rare Diseases, National Institutes of Health) This resource provides links to charitable or special fare flights to research and treatment sites, hospitality houses for patients and their families, and fee-for-service ambulance services. Phone: (301) 402-4336; website: http://rarediseases.info.nih. gov/resources/5#category17. Resources for Financial Assistance for Cancer Patients and Their Families (National Cancer Institute) This resource contains a database of government agencies and national organizations that provide financial assistance to patients with cancer and their families. In addition, it provides information about patient assistance programs. Phone: (800) 422-6237; website: www.cancer.gov/cancertopics/ coping/financial-legal. Understanding Prescription Assistance Programs (National Council on Patient Information and Education) This website provides resources for getting the right information about prescription assistance programs. Phone: (301) 340-3940; website: www.talkaboutrx.org/paps.jsp. Note: This newsletter is based on a thorough search conducted to identify government assistance programs; however, it is not intended to be a comprehensive list.

Patient support services are critical to helping patients with cancer navigate financial considerations in paying for care, especially cancer therapeutics. Summary

For patients with cancer and their families and caregivers, understanding the care delivery and payment process for cancer treatment can be daunting. We live in an era of unprecedented clinical advances in the treatment of cancer; however, costs have also risen sharply. As a result, patient support services are critical to helping patients with cancer navigate financial considerations in paying for care, especially cancer therapeutics. Many public and private organizations offer financial assistance http://innovationsinoncologymanagement.com

KEY POINTS ➤ Investment in cancer research has led to tremendous strides in the improvement of patient care, survival, and quality of life. ➤ New therapies have transformed certain cancers into chronic diseases, leading to vastly improved long-term survival. ➤ There is a considerable cost associated with cancer treatment; patients cycle through most or all of the possible approved agents, making treatment costs additive. ➤ Patients are expected to bear some of the cost of cancer therapy; however, the affordability of prescription drugs is a concern for patients, many of whom have difficulty paying their cost share. ➤ Patients have not filled prescriptions or reduced a prescribed dosage because of cost concerns; these instances of cost-related medication nonadherence have important implications for healthcare. ➤ There are a number of assistance programs for patients with cancer who are in need of financial support.

to patients with cancer who are in need. Many foundations and nonprofit entities have copayment programs to provide financial assistance to eligible patients. Other organizations serve as resources to help patients identify sources of funding. Furthermore, many pharmaceutical companies offer financial assistance to uninsured and underinsured patients. Virtually all of these programs have dedicated websites and toll-free contact numbers, making them easily accessible to patients and oncology practices.

As cancer innovation continues and accelerates in the coming years, the need for patient support services is more important than ever and will remain essential in the foreseeable future. n

References

1. Patel JD, Krilov L, Adams S, et al. Clinical cancer advances 2013: annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol. 2014;32:129-160. 2. National Cancer Institute. Managing the nation’s cancer research portfolio: professional judgment budget 2013. www.cancer.gov/aboutnci/budget_plan ning_leg/plan-2013. Accessed August 20, 2014. 3. IMS Institute for Healthcare Informatics. Innovation in Cancer Care and Implications for Health Systems: Global Oncology Trend Report. May 2014. www. imshealth.com/portal/site/imshealth/menuitem.762a961826aad98f53c 753c71ad8c22a/?vgnextoid=f8d4df7a5e8b5410VgnVCM10000076192ca2R CRD. Accessed August 19, 2014. 4. McKee AE, Farrell AT, Pazdur R, Woodcock J. The role of the U.S. Food and Drug Administration review process: clinical trial endpoints in oncology. Oncologist. 2010;15(suppl 1):13-18. 5. Express Scripts. The 2013 Drug Trend Report. April 2014. http://lab.expressscripts.com/~/media/pdfs/drug%20trend%20report/express%20scripts%20 2013%20drug%20trend%20report.ashx. Accessed August 19, 2014. 6. Harvard School of Public Health. Four in 10 Americans say they have trouble paying for drugs or skip prescriptions or cut pills due to cost. Press release. March 4, 2008. www.hsph.harvard.edu/news/press-releases/poll-usa-todaykaiser-harvard-prescription-drugs/. Accessed August 20, 2014. 7. Tseng CW, Dudley RA, Brook RH, et al. Elderly patients’ preferences and experiences with providers in managing their drug costs. J Am Geriatr Soc. 2007;55:1974-1980. 8. Kaiser Family Foundation. Kaiser health tracking poll: public opinion on health care issues. September 2009. http://kaiserfamilyfoundation.files.word press.com/2013/01/7990.pdf. Accessed August 21, 2014. 9. J Levy. Gallup. In U.S., uninsured rate lowest since 2008: uninsured rate declines most among blacks and lower-income Americans. April 7, 2014. www. gallup.com/poll/168248/uninsured-rate-lowest-2008.aspx. Accessed August 20, 2014. 10. Cubanski J, Neuman P. Status report on Medicare Part D enrollment in 2006: analysis of plan-specific market share and coverage. Health Aff (Millwood). 2007;26:w1-w12. 11. Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: associations with medication and medical utilization and spending and health. JAMA. 2007;298:61-69. 12. Hsu J, Price M, Huang J, et al. Unintended consequences of caps on Medicare drug benefits. N Engl J Med. 2006;354:2349-2359.

INNOVATIONS IN ONCOLOGY MANAGEMENT u 13

STAKEHOLDER PERSPECTIVE

Practical Considerations in Seeking Financial Assistance for Patients with Cancer An Interview with Patricia Krueger, RPh, Practice Administrator, Oncology & Hematology Specialists, P.A. Denville, NJ

n today’s competitive and challenging oncology practice environment, savvy practice administrators strive to provide superior customer service to their patients. As part of this effort, administrators and office staff seek to maximize third-party sources of funding to ensure that patients can afford their oncology medications. Many patients require assistance––some are uninsured or underinsured, while others incur significant out-of-pocket costs even if they have health insurance coverage. Practice administrators encounter many challenges in helping their patients locate sources of assistance during the course of their day-to-day responsibilities. Patricia Krueger, RPh, a community-based practice administrator based in Denville, NJ, sat down with Innovations in Oncology Management to discuss some of the practical considerations that practices may encounter when helping patients in need.

Q: Are oncology patients forthcoming about their need for financial assistance? If not, what questions do you ask to uncover their needs? Patricia Krueger (PK): Patients are usually forthcoming about their need for assistance after they learn how much they must pay out of pocket. When they come to the office for treatment, they are focused on the battle that they know lies ahead of them in fighting their cancer. It is not usually until after the benefits investigation that they become aware of how much it will cost them to treat their cancer. Few patients are proactive about the cost implications––it’s just not a priority for them.

Patients are usually forthcoming about their need for assistance after they learn how much they must pay out of pocket. Practices are aware of this and take control because most patients are unaware of financial support resources, and even if they were aware of the services available to them, they wouldn’t know how to access them. They are very appreciative when the practice takes the time to help them find financial assistance.

Q: In challenging situations, how do you keep office staff motivated to continue seeking financial assistance resources? 14 u OCTOBER 2014

PK: Office staff will sometimes “hit the wall” and become frustrated when they are thwarted in their efforts to secure financial assistance. In these situations, the practice administrator may step in and lend his or her experience in order to secure assistance for the patients. To ensure that the office staff is properly trained, the key is education. The more that the office staff is educated about the options available to patients and how to effectively navigate them, the more successful they will be in their efforts.

Q: What are the key differences in applying for manufacturer versus foundation/nonprofit

assistance? PK: Manufacturer programs tend to be more comprehensive in terms of the breadth of offerings they provide, but they are also more complicated and sometimes more challenging to navigate compared with foundation/nonprofit assistance. Of course, many different companies manufacture and market oncology drugs, so there are a large number of programs with different criteria, requirements, and benefits. The best manufacturer programs are easy to access, allow for electronic enrollment, and have a dedicated representative available to our practice and our patients. In our experience, foundation programs are more straightforward than manufacturer programs, and foundation programs are typically accessed only for financial assistance. In addition, they are not product-specific like manufacturer programs. As a result, we use a few programs that we have a good comfort level with; for example, Chronic Disease Fund and Patient Access Network Foundation come to mind. In addition, we tend to stick with the programs that we’ve had success with.

Q: How do you keep abreast of new patient support programs or changes to existing programs? PK: Foundations and nonprofit programs don’t usually change too much, but it can be very difficult to stay abreast of manufacturer programs, which change frequently. We generally rely on industry representatives to keep us informed. If there’s an immediate need, the practice administrator may be proactive in engaging industry representatives to ensure that the office staff is trained. This may happen with a new drug approval, a new indication for an approved drug, or if changes or enhancements have been made to the patient support program.

QQ: What are your most important challenges in terms of ac-

http://innovationsinoncologymanagement.com

cessing funding (timing of fund availability, eligibility requirements, etc)? PK: Manufacturer programs are relatively consistent in terms of funding, which is not necessarily the case with foundations. Some tumor types, such as breast cancer, may have consistent, generous funding available, while others, such as prostate cancer, may be underfunded at times. In cases where funding is scarce, we have to work a little harder to “find the money” for our patients. There may also be less transparency in terms of eligibility requirements for foundations compared with manufacturer programs. In addition, foundation programs always require documentation of income eligibility, while several manufacturer programs have loosened their level of scrutiny and now conduct periodic audits instead of requiring documentation for each patient. Documentation for financial assistance frequently requires disclosure of gross adjusted income, a term most patients are not familiar with; we often must explain these requirements to our patients.

QQ: How does your office coordinate financial support for cancer patients taking a combination of 2 or more expensive drugs? Is it a challenge? PK: It is a challenge insofar as we must apply separately to different programs if the drugs are marketed by different manufacturers, so it’s twice the amount of work for the office. For patients taking multiple branded drugs, these programs are literally a

KEY POINTS ➤ When patients come to the office for treatment, they are focused on the battle ahead of them in fighting their cancer; it is not until after a benefits investigation that they become aware of how much their care will cost them. ➤ To ensure that the office staff is properly trained, the key is education; the more the office staff is educated about options available to patients, the more successful they will be. ➤ The best manufacturer programs are easy to access, allow for electronic enrollment, and have a dedicated representative available. ➤ The barriers to coverage and patient assistance may be different for drugs prescribed outside of approved product labeling. ➤ Oncology practices should take the time to learn about the range of programs and services available to patients; becoming familiar with these details in advance can save time later.

lifeline, because there is no way they could afford to pay for the out-of-pocket cost of these drugs without assistance. Sometimes this is the case even if the patient has insurance.

Oncology practices should take the time to learn about the range of programs and services available to patients, including eligibility and documentation requirements. Becoming familiar with the details in advance can save time later.

QQ: Is it a challenge to secure funding for drugs that have been

prescribed off-label? PK: The barriers to coverage and patient assistance may be different for drugs prescribed outside of approved product labeling. Although an oncology drug may be covered by commercial or Medicare payers, even for off-label use, it does not necessarily mean that manufacturer programs and/or foundations will provide financial assistance in these situations.

Q: Do you ever ask oncologists to prescribe a different drug because funding is not available? How receptive are they to these requests? PK: Yes, there are situations where we ask them to prescribe an alternate therapy if it is therapeutically equivalent or close to equivalent. Most of the time, our oncologists are understanding in these situations.

Q: Do any of your patients require transportation assistance? How do you help them? PK: Yes, we do have some patients who require transportation assistance. When that happens, the office staff helps to coordinate transportation with local nonprofit services, which are often offered by local hospitals. Some manufacturer programs also help to coordinate transportation assistance for patients in need.

Q: Thank you for taking the time to speak with us today. Do you have any final thoughts to share with your colleagues? PK: It takes a considerable amount of time and resources to enroll patients in financial assistance programs and provide the necessary documentation, but it is something we are glad to do in order to retain our patients and help them access their oncology medications. Oncology practices should take the time to learn about the range of programs and services available to patients, including eligibility and documentation requirements. Becoming familiar with the details in advance can save time later.

INNOVATIONS IN ONCOLOGY MANAGEMENT u 15