Oncology Pharmacy Services

Transcript

00:00 --> 00:02Support for Yale Cancer Answers
00:02 --> 00:04comes from AstraZeneca, dedicated
00:05 --> 00:07to advancing options and providing
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00:10 --> 00:13More information at astrazeneca-us.com.
00:13 --> 00:15Welcome to Yale Cancer Answers with
00:15 --> 00:18your host doctor Anees Chagpar.
00:18 --> 00:20Yale Cancer Answers features the
00:20 --> 00:22latest information on cancer care by
00:22 --> 00:24welcoming oncologists and specialists
00:24 --> 00:27who are on the forefront of the
00:27 --> 00:29battle to fight cancer. This week
00:29 --> 00:31it's a conversation about medication
00:31 --> 00:32assistance programs with
00:32 --> 00:34Nancy Beaulieu and Brenda Sepulveda.
00:34 --> 00:35Nancy is associate director
00:35 --> 00:37of oncology pharmacy services.
00:37 --> 00:40And Brenda is
00:40 --> 00:41medication Assistance program coordinator.
00:41 --> 00:44Doctor Chagpar is a professor
00:44 --> 00:47of surgical oncology at the Yale
00:47 --> 00:49University School of Medicine.
00:49 --> 00:52Nancy, maybe I'll start with you.
00:52 --> 00:55Tell me a little bit more about
00:55 --> 00:58yourself and what it is you do.
00:58 --> 01:01We essentially mix chemotherapy and
01:01 --> 01:04assure that all medication safety
01:04 --> 01:06practices are in order for all of our
01:06 --> 01:08patients within our
01:08 --> 01:10network.
01:10 --> 01:12Brenda, how about you?
01:12 --> 01:13I am the medication assistance program coordinator.
01:13 --> 01:16I am part of a group that
01:16 --> 01:18assists patients with medication
01:18 --> 01:20programs that require copay
01:20 --> 01:21or foundation funding.
01:21 --> 01:23So Nancy,
01:23 --> 01:27from a big you know 30,000 foot picture,
01:27 --> 01:29how often is it that patients actually
01:29 --> 01:32have issues in paying for medications?
01:32 --> 01:35I think that on this show we've
01:35 --> 01:38often talked about novel therapies,
01:38 --> 01:40the latest in clinical trials,
01:40 --> 01:41new targeted drugs.
01:41 --> 01:45But all of that comes at a cost.
01:45 --> 01:48How much of a problem is it?
01:48 --> 01:48The financial
01:48 --> 01:51burden of many of the new
01:51 --> 01:53medications that come out?
01:53 --> 01:54All patients
01:54 --> 01:56with long term chronic diseases,
01:56 --> 01:58cancer included, have
01:58 --> 02:00significant stressors to deal with.
02:00 --> 02:02They have emotional stress.
02:02 --> 02:04They have mental, physical stress,
02:04 --> 02:06but one of the greatest stressors
02:06 --> 02:08that they deal with that's a burden
02:08 --> 02:11not only to the patient themselves
02:11 --> 02:14but also their family is the stress
02:14 --> 02:16of the financial component of how
02:16 --> 02:19they're going to pay for their therapy,
02:19 --> 02:20their treatments.
02:20 --> 02:22Financial toxicity is a newer buzz
02:22 --> 02:25term that we are using to describe
02:25 --> 02:27the some of the financial side affects
02:27 --> 02:30associated with the economic burden
02:30 --> 02:32of care and medications placed on
02:32 --> 02:34these patients and their families.
02:34 --> 02:37It is a significant issue and that is
02:37 --> 02:41one of the reasons why as long as
02:41 --> 02:4412 years ago we went into developing
02:44 --> 02:47a mechanism to assist patients with
02:47 --> 02:50some of this financial burden.
02:50 --> 02:52And just staying with you on that,
02:52 --> 02:55I mean aren't many of
02:55 --> 02:58these therapies covered by insurance
02:58 --> 03:00or are people still having
03:00 --> 03:02Financial hardship despite insurance?
03:02 --> 03:05We have many patients who have either
03:05 --> 03:07inadequate health care insurance or
03:07 --> 03:10they have health care insurance
03:10 --> 03:13but the out of pocket costs of many of
03:13 --> 03:16these therapies can be extreme and a
03:16 --> 03:20severe burden on their financial outcome.
03:20 --> 03:21There are significant rising
03:21 --> 03:23costs and medications.
03:23 --> 03:26All new meds that do come out,
03:26 --> 03:29and certainly they provide hope for
03:29 --> 03:31many patients, but they
03:31 --> 03:33do come with a cost,
03:33 --> 03:35and that is one of the things
03:35 --> 03:37that we really need to work with.
03:37 --> 03:40And we have been doing that
03:40 --> 03:42for over 10 years.
03:42 --> 03:43For our patients,
03:43 --> 03:45both here and in the
03:45 --> 03:46outpatient specialty pharmacy,
03:46 --> 03:48they also have medication
03:48 --> 03:49assistance program coordinators.
03:49 --> 03:51Brenda tell us a little
03:51 --> 03:54bit more about how that works.
03:54 --> 03:57I mean, I can imagine that cancer patients
03:57 --> 04:00are faced with a diagnosis of cancer,
04:00 --> 04:03which is enough of a burden,
04:03 --> 04:04physically, mentally, emotionally.
04:04 --> 04:07And then
04:07 --> 04:09their doctor prescribes a chemotherapy
04:09 --> 04:11regimen or certain medications,
04:11 --> 04:14and then whether they have insurance or not,
04:14 --> 04:18they are faced with a rather large bill.
04:18 --> 04:22So how do you help them to get around that?
04:22 --> 04:24And is there a difference between
04:24 --> 04:26the assistance that's available
04:26 --> 04:28for uninsured patients versus
04:28 --> 04:30the assistance that's available
04:30 --> 04:32for people who have insurance
04:32 --> 04:36but might not be adequate?
04:37 --> 04:39And staying with that topic,
04:39 --> 04:41we know that the financial burden
04:41 --> 04:44is a big concern and part of what
04:44 --> 04:47we do within our program is to
04:47 --> 04:49ensure that the patient is able
04:49 --> 04:52to remain on the preferred course
04:52 --> 04:54of therapy while focusing on their
04:54 --> 04:56health care journey and so for
04:56 --> 04:59the patients that are insured but
04:59 --> 05:01maybe under insured because they
05:01 --> 05:03still have high out of pockets,
05:03 --> 05:05we assist with those copay
05:05 --> 05:06assistance programs.
05:06 --> 05:09There are manufacturer sponsored Copay
05:09 --> 05:11Foundation funding or replacement programs.
05:11 --> 05:13There's a difference with the
05:13 --> 05:16patient that is insured and also
05:16 --> 05:20that has no insurance and so we will
05:20 --> 05:23go depending on what the status is
05:23 --> 05:26to the preferred program to ensure
05:26 --> 05:28that they are able to remain on
05:28 --> 05:30that therapy without interruptions
05:30 --> 05:33and without having to deplete their
05:33 --> 05:35own personal income throughout
05:35 --> 05:37their therapy journey.
05:37 --> 05:40Tell me more about that, Brenda,
05:40 --> 05:42because I'm sure that
05:42 --> 05:45many of our listeners are really
05:45 --> 05:47rather intrigued about how
05:47 --> 05:49there is assistance available,
05:49 --> 05:52so let's take the two examples.
05:52 --> 05:55So the first is for people who have
05:55 --> 05:58insurance but they are still under insured.
05:58 --> 06:00Their out of pocket costs are
06:00 --> 06:03too much for them to bear,
06:03 --> 06:05so how do they access these programs
06:05 --> 06:08and what programs are available?
06:08 --> 06:10Would they cover all of their
06:10 --> 06:12out of pocket costs?
06:12 --> 06:14You mentioned that these are programs
06:14 --> 06:16available through the manufacturers.
06:16 --> 06:20Can you tell us more about that?
06:20 --> 06:22Sure, so patients are able
06:22 --> 06:24to access the manufacturer
06:24 --> 06:27sponsored programs as soon as they
06:27 --> 06:29identify what medications they're
06:29 --> 06:31having a financial concern with.
06:31 --> 06:34Typically it can go through providers
06:34 --> 06:37where they will also have access to
06:37 --> 06:40this pharmacy services and will be
06:40 --> 06:44contacted to then do a little more
06:44 --> 06:46research within the manufacturer program.
06:46 --> 06:48So someone who has insurance
06:48 --> 06:50but is underinsured,
06:50 --> 06:53means that they still have a high out
06:53 --> 06:55of pocket cost to that medication and
06:55 --> 06:57this can occur many times
06:57 --> 06:58within the treatment.
06:58 --> 07:02So what we do is take care of the portion
07:02 --> 07:04that is pertaining to the medication.
07:04 --> 07:07A lot of programs may allow the financial
07:07 --> 07:10eligibility to go towards other costs
07:10 --> 07:11during that appointment,
07:11 --> 07:12but typically will go geared
07:12 --> 07:14towards the medication, and
07:14 --> 07:17that's our main focus because we
07:17 --> 07:19know that that's where the out
07:19 --> 07:21of pocket costs tends to fall under,
07:21 --> 07:24and that's where it's mostly
07:24 --> 07:27when it comes to the treatment.
07:27 --> 07:30So for someone who is
07:30 --> 07:31underinsured or uninsured, then
07:31 --> 07:34we will follow the same protocol.
07:34 --> 07:37If there's a concern that's been extended
07:37 --> 07:40to the provider and we are aware of that,
07:40 --> 07:42or the patient may have been
07:42 --> 07:44able to gather some information
07:44 --> 07:46through the manufacturer's website,
07:46 --> 07:49then we go ahead and become sort of
07:49 --> 07:52a gateway for the patient in the
07:52 --> 07:54programs and our providers to make
07:54 --> 07:57sure that they are properly enrolled
07:57 --> 07:59and that the process of submissions
07:59 --> 08:01for those out of pocket costs
08:01 --> 08:04are processed correctly and the patient
08:04 --> 08:06doesn't have to worry about any of
08:06 --> 08:09that during the course of their therapy.
08:09 --> 08:12So someone who is uninsured may be
08:12 --> 08:15eligible to actually have access to
08:15 --> 08:17the medication replacement programs
08:17 --> 08:19through the insurance as well.
08:19 --> 08:22By us having to go through the
08:22 --> 08:23programs for the
08:23 --> 08:24manufacturers.
08:24 --> 08:26Nancy, it sounds like there are
08:27 --> 08:28some programs through manufacturers
08:28 --> 08:30that patients can become familiar
08:30 --> 08:32with through their website,
08:32 --> 08:35but I'm just wondering how many
08:35 --> 08:36patients actually
08:36 --> 08:38have done the research,
08:38 --> 08:40have gone to manufacturers websites
08:40 --> 08:42to figure out whether or not they
08:42 --> 08:44would be eligible for assistance.
08:44 --> 08:48I mean, I'm not sure that if I was a
08:48 --> 08:52patient I would necessarily know to do that.
08:53 --> 08:55I think that was one of
08:55 --> 08:57the reasons for us to
08:57 --> 08:59actually develop this program,
08:59 --> 09:00because patients weren't aware,
09:00 --> 09:02it's not well publicized.
09:02 --> 09:04If you go to the programs website,
09:07 --> 09:09you can certainly see everyone
09:09 --> 09:11has a patient assistance tab.
09:11 --> 09:14But quite often patients are unaware
09:14 --> 09:17of that and that is why we chose to
09:17 --> 09:19make it a formalized program and
09:19 --> 09:22not another burden on the patient
09:22 --> 09:25for them to have to manage.
09:25 --> 09:28We have currently 7 medication
09:28 --> 09:29assistance program coordinators
09:29 --> 09:32and over 16,000 currently enrolled
09:32 --> 09:34active patients in the program
09:34 --> 09:37that I oversee with my MAP
09:37 --> 09:40program coordinators.
09:41 --> 09:43Brenda, it's great that there is this
09:43 --> 09:46program through the Smilow network,
09:46 --> 09:50but I'm just thinking about other
09:50 --> 09:54patients who may be listening to this
09:54 --> 09:57who may not be linked in to
09:57 --> 10:00the Smilow network if they were to
10:00 --> 10:03go to the websites of all
10:03 --> 10:06of the drugs that they are on and
10:06 --> 10:08I agree with you Nancy,
10:08 --> 10:11that is yet another burden for patients,
10:11 --> 10:14but can you give us a little bit
10:14 --> 10:17of guidance in terms of
10:17 --> 10:19who would be eligible?
10:19 --> 10:21Are there certain income guidelines or
10:21 --> 10:23certain employment guidelines?
10:23 --> 10:26How do these programs decide
10:26 --> 10:30who gets assistance and who doesn't?
10:31 --> 10:32With the programs,
10:32 --> 10:35if a patient identifies that burden,
10:35 --> 10:37and knows that there's something
10:37 --> 10:40there that they need assistance with,
10:40 --> 10:43and it's not within this community
10:43 --> 10:46they can definitely ask for assistance
10:46 --> 10:49with their providers or their
10:49 --> 10:52preferred office for their treatment area.
10:52 --> 10:55What that does is that the manufacturer
10:55 --> 10:58gives the information to the patient on
10:58 --> 11:02how to go about the application process and
11:02 --> 11:05involving the providers office as well.
11:05 --> 11:08So it's definitely geared to assist
11:08 --> 11:11the patient and have the providers
11:11 --> 11:14office be able to be a part of
11:14 --> 11:17that with the patient so that the
11:17 --> 11:19enrollment process is successful.
11:19 --> 11:22A lot of the income criteria is
11:22 --> 11:25based on whether there is employment,
11:25 --> 11:27whether there is a retirement
11:27 --> 11:29or household size.
11:29 --> 11:32So a lot of the programs will have
11:32 --> 11:35that kind of criteria for patients to
11:35 --> 11:38be able to be eligible.
11:38 --> 11:41As long as they're on that therapy
11:41 --> 11:43income household size are some of
11:43 --> 11:45the things that they will look at.
11:45 --> 11:48Especially true for people who are insured
11:48 --> 11:50that the therapy has been approved
11:50 --> 11:52by the insurance in order to proceed.
11:52 --> 11:55If we're talking about copay assistance,
11:56 --> 11:59and Nancy back to you,
11:59 --> 12:02I'm just wondering,
12:02 --> 12:04there are people out there who are
12:04 --> 12:07underinsured, but they may be making
12:07 --> 12:09the income or barely making the
12:09 --> 12:11income requirement such that they
12:11 --> 12:13would not qualify for assistance,
12:13 --> 12:16but they may be doing that
12:16 --> 12:17by working three jobs,
12:17 --> 12:22and trying to make ends meet.
12:22 --> 12:24And so it kind of begs the question
12:24 --> 12:26when these patients are going
12:26 --> 12:29through cancer and they are
12:29 --> 12:32automatically in a situation where they
12:32 --> 12:35may be losing some of that income.
12:35 --> 12:37But they are still quote employed,
12:39 --> 12:41but especially if they were making
12:41 --> 12:43income based on an hourly wage.
12:43 --> 12:46So while they may have employment status,
12:46 --> 12:48and if the application said
12:48 --> 12:51show me what your income was in
12:51 --> 12:54the past year, they may have been
12:54 --> 12:57scraping by with more than the
12:57 --> 13:00bare minimum that's required for assistance.
13:00 --> 13:02Is it something that you advise
13:02 --> 13:05people to actually quit one of their
13:05 --> 13:07jobs or reduce their income so that
13:07 --> 13:09they can avail themselves of this
13:09 --> 13:12assistance or how does that work?
13:25 --> 13:28I think the first part of
13:28 --> 13:31that question that I'd like to
13:31 --> 13:34address has to do with what the
13:34 --> 13:37income requirements are and
13:37 --> 13:40historically, for many of these programs,
13:40 --> 13:43the income requirement is quite high,
13:43 --> 13:46so that should be of comfort
13:46 --> 13:49to anyone who wants to
13:49 --> 13:50apply for these programs as
13:50 --> 13:52well as continue to work.
13:52 --> 13:54Many of them are extremely high and
13:54 --> 13:57I don't know how many patients
13:57 --> 13:59currently that we have that don't
13:59 --> 14:01get accepted because of their income,
14:02 --> 14:05but the majority do get accepted.
14:05 --> 14:08I guess I could say that I wouldn't
14:08 --> 14:11recommend anyone quit a job unless that
14:11 --> 14:13is their personal choice to do so.
14:13 --> 14:15And a lot of our patients,
14:15 --> 14:18if you are being treated for chronic disease,
14:18 --> 14:21often have
14:21 --> 14:24issues with working anyway because
14:24 --> 14:28you are in constant treatment and
14:28 --> 14:31even if it's a temporary time frame,
14:31 --> 14:35we can also petition these companies as well,
14:35 --> 14:37or the patient can for exceptions
14:37 --> 14:40so their tax return last year may
14:40 --> 14:43be far higher than it is this year
14:43 --> 14:45because they unfortunately
14:45 --> 14:48became ill and they they cannot
14:48 --> 14:50hold their job any longer.
14:50 --> 14:52So there are other options.
14:52 --> 14:55There are also foundation programs as well,
14:55 --> 14:58so the manufacturers are one.
14:58 --> 15:00There are grant programs which
15:00 --> 15:02fall under the foundation category.
15:02 --> 15:04That's another option as well for patients.
15:05 --> 15:06All good information.
15:06 --> 15:09We're going to pick up this
15:09 --> 15:11conversation right after we take a
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15:25 --> 15:26about colorectal cancer.
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15:57 --> 16:00You're listening to Connecticut public radio.
16:02 --> 16:04Welcome back to Yale Cancer Answers.
16:04 --> 16:07This is doctor Anees Chagpar
16:07 --> 16:09and I'm joined tonight
16:09 --> 16:11by my guests
16:11 --> 16:13Nancy Beaulieu and Brenda Sepulveda
16:13 --> 16:16and we are talking about oncology pharmacy services and particularly
16:16 --> 16:18the financial toxicity that many patients
16:18 --> 16:20face when undergoing cancer therapy.
16:20 --> 16:23Right before the break we
16:23 --> 16:25were talking about some financial
16:25 --> 16:27assistance programs and Nancy,
16:27 --> 16:31it was so great to hear that
16:31 --> 16:34the income requirements
16:34 --> 16:37for assistance are actually quite high,
16:37 --> 16:41so if you are in financial distress
16:41 --> 16:46when you get the bill for your medications,
16:46 --> 16:50you can go to the
16:50 --> 16:52pharmaceutical manufacturers website to
16:52 --> 16:56try to find a patient assistance program.
16:56 --> 16:59Talk to your provider and
16:59 --> 17:02certainly at Smilow there is the
17:02 --> 17:05Medication assistance program that
17:05 --> 17:08you mentioned. Brenda, my question to
17:08 --> 17:11you is are all medications covered?
17:11 --> 17:12So for example,
17:12 --> 17:15are all chemotherapies covered?
17:15 --> 17:18Does that only include IV therapies?
17:18 --> 17:20What about oral therapies?
17:20 --> 17:22Are there certain medications that
17:22 --> 17:25don't have a patient assistance program
17:25 --> 17:29like novel immunotherapies?
17:29 --> 17:32What's included and what isn't?
17:33 --> 17:35While there are hundreds of
17:35 --> 17:38medications that are covered and
17:38 --> 17:40we often find a lot of eligible
17:40 --> 17:43programs to assist our patients with,
17:43 --> 17:45there will be some that will have some
17:45 --> 17:48type of restrictions or some requirement.
17:48 --> 17:51We find that a lot of the immuno
17:51 --> 17:54therapies are eligible for these programs,
17:54 --> 17:56but it's really something that
17:56 --> 17:59we will research and know at the
17:59 --> 18:01time of the current treatment,
18:01 --> 18:03so there will be other factors there
18:03 --> 18:06that will have to look
18:06 --> 18:08at and see if there's an eligibility
18:08 --> 18:11requirement that will allow them to
18:11 --> 18:14participate in the manufacturer programs,
18:14 --> 18:15but there's definitely hundreds
18:15 --> 18:17of programs available for the
18:17 --> 18:20chemotherapies.
18:20 --> 18:23Nancy, is this something that is
18:23 --> 18:25discussed with the patient and
18:25 --> 18:27the provider before the provider
18:27 --> 18:29makes a treatment regimen?
18:29 --> 18:32Or is this something that the
18:32 --> 18:34patients are then scrambling to do
18:34 --> 18:36after the provider has written
18:36 --> 18:38out their recommended treatment?
18:40 --> 18:43The providers generally write out
18:43 --> 18:45what's recommended because that
18:45 --> 18:48is where we want to go with the
18:48 --> 18:50therapeutic direction for the patient.
18:50 --> 18:51After that, however,
18:51 --> 18:55quite often we have to assure that the
18:55 --> 18:58patient's medications are going to be covered.
18:58 --> 19:00That's the first step.
19:00 --> 19:03If a patient is insured and if
19:03 --> 19:05we get denials, then we step in.
19:05 --> 19:08We do have what's called a medication
19:08 --> 19:10assistance program brochure that we
19:10 --> 19:14provide in all of our offices so they
19:14 --> 19:16are available to patients before they
19:16 --> 19:21ever even go into the physician practice.
19:21 --> 19:25Many times the
19:25 --> 19:27program coordinators are working
19:27 --> 19:29on the back end,
19:29 --> 19:34so in our program we work with
19:34 --> 19:38determining how much of a
19:38 --> 19:40bill that the patient may have
19:40 --> 19:42once insurance has gone through
19:42 --> 19:45and then we go and pinpoint certain
19:45 --> 19:47programs for those patients.
19:47 --> 19:49We actually have a software that
19:49 --> 19:52assists us with that as well
19:52 --> 19:54in the general population.
19:54 --> 19:56Again, as you had mentioned,
19:56 --> 19:58patients can go to websites.
19:58 --> 20:00Always include your provider on what
20:00 --> 20:03forms you have filled out to
20:03 --> 20:05make sure there's not
20:05 --> 20:08duplicative work going on there,
20:08 --> 20:12which has happened to us in the past.
20:12 --> 20:14So that these patients can get the
20:14 --> 20:17most out of these programs.
20:17 --> 20:20To do a little bit of a spin in regards
20:20 --> 20:23to your previous question about
20:23 --> 20:25availability and drugs that have programs,
20:25 --> 20:28what we find is anything that
20:28 --> 20:30is new and highly expensive.
20:30 --> 20:32Definitely have patient assistance programs.
20:32 --> 20:36Many of the older therapies that are.
20:36 --> 20:39Generic at this point may not.
20:39 --> 20:42It's really focused quite often on the
20:42 --> 20:45higher cost or higher end medications,
20:45 --> 20:47and there are definitely medication
20:47 --> 20:50assistance programs for oral medications.
20:50 --> 20:53Even at your
20:53 --> 20:55local CVS or Walgreens patients
20:55 --> 20:58should always be asking what's
20:58 --> 21:00out there to assist them.
21:00 --> 21:03If they can't afford any
21:03 --> 21:05medication that they may need.
21:06 --> 21:10And so when you determine
21:10 --> 21:14upfront what the cost of therapy would be,
21:14 --> 21:17is that done before the therapy
21:17 --> 21:20actually starts?
21:20 --> 21:23Brenda are you intervening before
21:23 --> 21:26a treatment starts to say OK,
21:26 --> 21:29this is what the cost would be.
21:29 --> 21:32Can you afford it or can you not?
21:32 --> 21:35Can we get all of these programs
21:35 --> 21:38and the applications into
21:38 --> 21:40assistance before you start so
21:40 --> 21:43that the damage is
21:43 --> 21:45going to be financially afterwards?
21:45 --> 21:48Or is this something that is
21:48 --> 21:50kind of being done
21:50 --> 21:52after I've already started therapy
21:52 --> 21:55and in tandem with that so that I
21:55 --> 21:56don't really have a choice except
21:56 --> 21:58to hope that I get accepted.
22:00 --> 22:02Typically, as Nancy
22:02 --> 22:03mentioned, once the treatment plan
22:03 --> 22:06is in place by the provider,
22:06 --> 22:08and we know that this is the
22:08 --> 22:10preferred course of therapy,
22:10 --> 22:13it's going to undergo that if there's an
22:13 --> 22:15insurance involvement or lack of insurance,
22:15 --> 22:18it'll go through that process of referral,
22:18 --> 22:21and that will sort of let us know
22:21 --> 22:23when we necessarily need to step in,
22:23 --> 22:27and if there will be high cost
22:27 --> 22:30towards the treatment plan.
22:30 --> 22:33We do have our own software where we
22:33 --> 22:37on the back end try to capture as many
22:37 --> 22:40patients beforehand, when this isn't possible,
22:40 --> 22:43what's great about the programs is
22:43 --> 22:46that some of them have look back
22:46 --> 22:49periods that go up to 180 days.
22:49 --> 22:51So even if a patient has
22:51 --> 22:52initiated the treatment,
22:52 --> 22:55there's still time for enrollment and
22:55 --> 22:58to capture that date of service that
22:58 --> 23:01was already served or infused
23:01 --> 23:04prior to the enrollment for the
23:04 --> 23:05programs.
23:05 --> 23:08Nancy, my question is,
23:08 --> 23:10it's great that there's a look
23:10 --> 23:12back program in that maybe
23:12 --> 23:14you'll be able to apply for that
23:14 --> 23:16assistance going backwards.
23:16 --> 23:18But what if, even with assistance,
23:18 --> 23:21it is still too expensive?
23:22 --> 23:24One would anticipate that
23:24 --> 23:26making all of those applications
23:26 --> 23:28to these pharma companies and
23:29 --> 23:31getting all of the
23:31 --> 23:33T's crossed and I's dotted to
23:33 --> 23:34get assistance takes some time.
23:34 --> 23:35So meanwhile,
23:35 --> 23:37you're starting therapy without
23:37 --> 23:39knowing whether you're going
23:39 --> 23:41to get assistance and how much
23:41 --> 23:43and so at the end of the day,
23:43 --> 23:45you may still be left with the bill.
23:45 --> 23:47On the other hand,
23:47 --> 23:49if you try to apply for all
23:49 --> 23:51of the assistance up front,
23:51 --> 23:53you're now delaying your treatment,
23:53 --> 23:57and it's kind of a bit of a tug.
23:57 --> 23:58How do you work
23:58 --> 24:01around that?
24:01 --> 24:03The way we process treatment plan orders
24:03 --> 24:06once the physician decides what the
24:06 --> 24:09best course of therapy is, they go to
24:09 --> 24:11what's called a patient account Rep.
24:11 --> 24:13That person does an insurance
24:13 --> 24:15verification on the patient's therapy.
24:15 --> 24:16So before a patient gets treated,
24:16 --> 24:20they have to have a pre
24:20 --> 24:22certification of those meds.
24:22 --> 24:24If, for example, an insurance says no,
24:24 --> 24:26we're not paying for a certain Med
24:26 --> 24:29that is a trigger for the MAP program.
24:29 --> 24:31All of the providers are fully well
24:31 --> 24:33aware of our MAP program coordinators,
24:33 --> 24:35and they know that they can reach
24:35 --> 24:37out if they think this
24:37 --> 24:39patient needs a specific
24:39 --> 24:41drug they will reach out to the
24:41 --> 24:43MAP program coordinator and say,
24:43 --> 24:45hey this got denied by insurance.
24:45 --> 24:47Can you help and those are some
24:47 --> 24:49of the routes we go down,
24:49 --> 24:51but in patients whose insurance
24:51 --> 24:53companies say they're not going to,
24:54 --> 24:56we'll know upfront before they
24:56 --> 24:57ever get treated.
24:59 --> 25:04When we enroll patients in the MAP programs
25:04 --> 25:06that is usually an acceptance,
25:06 --> 25:08or at least the coordinator knows
25:08 --> 25:10that the patient meets criteria.
25:10 --> 25:13So there is some level of comfort there
25:13 --> 25:16that that person will get into that
25:16 --> 25:19program before they start being treated.
25:19 --> 25:21Some of the programs we actually have to
25:21 --> 25:24treat the patient first, have the insurance
25:24 --> 25:27deny the bill before the program.
25:27 --> 25:30One of the ways we get assistance
25:30 --> 25:33is they actually send us the
25:33 --> 25:35physical drug vials back
25:35 --> 25:37to replenish our supply so the patient
25:37 --> 25:41never gets billed for that particular drug,
25:41 --> 25:43so that's another way there's
25:43 --> 25:44copay assistance where they
25:44 --> 25:47actually assist with insured copay.
25:47 --> 25:49There's also the medication vial assistance
25:49 --> 25:52where the actual physical drug gets
25:52 --> 25:54replaced after the patient gets it,
25:54 --> 25:56and is insurance denied.
25:56 --> 25:57Yeah, but that
25:57 --> 26:00must be scary for the patient to you
26:00 --> 26:03know now gets their insurance denied
26:03 --> 26:08and are thinking Oh my God, am I
26:08 --> 26:11responsible for that cost.
26:11 --> 26:13So back to you Brenda.
26:13 --> 26:16You know we've talked a little
26:16 --> 26:18bit about the outpatient,
26:18 --> 26:20the infusion chemotherapy.
26:20 --> 26:22Nancy mentioned that oral
26:22 --> 26:23therapies are covered.
26:23 --> 26:26What about in emergent situations
26:26 --> 26:29where patients are in the hospital
26:29 --> 26:33and may not be having these in-depth
26:33 --> 26:35conversations with their physician
26:35 --> 26:39about how much this is going to cost?
26:39 --> 26:42Do these programs cover patients
26:42 --> 26:44in that situation?
26:44 --> 26:45And if not,
26:45 --> 26:49how do they deal with that on top of an
26:49 --> 26:51overwhelming cost of hospitalization?
26:53 --> 26:56A lot of the programs are geared towards
26:56 --> 26:58the outpatient ambulatory status,
26:58 --> 27:01where MAP can essentially interfere
27:01 --> 27:04or give some advice.
27:04 --> 27:07If there is already a discharge
27:07 --> 27:11plan and we need to look ahead for
27:11 --> 27:13that treatment course when there
27:13 --> 27:15is a hospitalization already taken
27:15 --> 27:17place and it requires treatment,
27:17 --> 27:20there may be other financial assistance
27:20 --> 27:23that can go through billing too.
27:24 --> 27:26But the manufacturing programs are
27:26 --> 27:28essentially here to our outpatient
27:28 --> 27:30infusion status with the oral
27:30 --> 27:33medications going towards the pharmacy
27:33 --> 27:35medication assistance program.
27:35 --> 27:37So there is a difference there
27:37 --> 27:40when it comes to an inpatient and
27:40 --> 27:43outpatient and who is eligible
27:43 --> 27:45for these types of programs.
27:45 --> 27:47So Nancy, what
27:47 --> 27:50advice do you have for patients
27:50 --> 27:53who might be facing
27:53 --> 27:55a cancer diagnosis and
27:55 --> 27:56might be worried
27:56 --> 27:58not only about their cancer,
27:58 --> 28:00but also about the cost?
28:00 --> 28:01What should they do?
28:01 --> 28:04My greatest advice would be to become
28:04 --> 28:06as informed as you possibly can.
28:06 --> 28:09Know the names of your drugs you're getting.
28:09 --> 28:12Get on to those websites, see what their
28:12 --> 28:13patient assistance programs offer.
28:13 --> 28:15Talk with your physicians,
28:15 --> 28:17their nurses, their front desk staff.
28:17 --> 28:20And hopefully then they can actually
28:20 --> 28:23assist and know what they are able
28:23 --> 28:25to get up front and know that there
28:25 --> 28:28is a way and a safety net for them
28:28 --> 28:31when those bills do come in to
28:31 --> 28:32avoid this financial toxicity.
28:33 --> 28:35Nancy is associate
28:35 --> 28:37director of oncology pharmacy
28:37 --> 28:38services for the Smilow network.
28:38 --> 28:40And Brenda Sepulveda is medication
28:40 --> 28:42assistance program coordinator.
28:42 --> 28:43If you have questions,
28:43 --> 28:45the address is canceranswers@yale.edu
28:45 --> 28:47and past editions of the program
28:47 --> 28:49are available in audio and written
28:49 --> 28:51form at yalecancercenter.org.
28:51 --> 28:54We hope you'll join us next week to
28:54 --> 28:57learn more about the fight against
28:57 --> 29:00cancer here on Connecticut Public Radio.

Information

Oncology Pharmacy Services with guests Nancy Beaulieu and Brenda Sepulveda June 20, 2021 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095