Utilization of Pharmaceutical Patient and Prescription Assistance Programs via a Pharmacy Department Patient Assistance Program for Indigent Cancer Patients

e17537 Background: With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading therapeutic classes in hospital drug expenditures. Lack of insurance is associated with lower rates of cancer screening, later stage at diagnosis, and increased cancer mortality. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at NUMC with drug costs for chemotherapies and maintain the quality care for patients, the Pharmacy department instituted a Patient Assistance Program (PAP) to obtain medication from the drug companies at no cost. NUMC is a “safety net” teaching hospital in suburban New York. It serves mostly an indigent population and is a Level 1 Trauma Center with over 77,000 emergency department visits per year. Methods: We followed all patients requiring assistance with chemotherapy who enrolled in our PAPs from January 1, 2011 to December 31, 2012. Individuals potentially eligible for PAPs were identified by Oncologists and by the pharmacy department. Medications included both oral and parenteral chemotherapy drugs and antiemetics. Results: The program served 341 patients in 2011 and 579 patients in 2012. The total number of visits in the clinic over 24 months was 9,405. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. Conclusions: PAPs provide a valuable safety net to ensure that cancer patients without insurance receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. A pharmacy-based program to procure free medications for uninsured cancer outpatients has helped to defray the Cancer Care Center’s expense of providing care at NUMC, increased patients’ compliance with chemo-protocols and allowed many patients to receive the treatment they otherwise would not be able to afford.

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A medication acquisition program to facilitate access to nonstandard targeted oncologic therapies.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e13505 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e13505-e13505

Author(s):

Vicki Doctor ◽

Maurie Markman ◽

Ankur Rasik Parikh ◽

Bellinda Conte

Keyword(s):

Cancer Patients ◽

Targeted Therapies ◽

Insurance Coverage ◽

Standard Of Care ◽

Consecutive Series ◽

Precision Oncology ◽

Tumor Type ◽

Assistance Programs ◽

Off Label ◽

Patient Assistance

e13505 Background: Precision oncology provides targeted approaches to cancer diagnosis and treatment, but also carries significant risks to reimbursement and patient access. A recent survey found that up to 60% of authorization denials are due to the therapy being off-label and experimental. The Cancer Treatment Centers of America's Medication Acquisition Program (CTCA-MAP) was initiated in October 2015 with the goal of helping patients successfully navigate a medication acquisition process following prior authorization denials for off-label therapy. Methods: A consecutive series of cancer patients who were non-responsive to standard-of-care, and for whom off-label targeted therapies have been matched to a potentially actionable genetic or molecular variant were enrolled into CTCA-MAP following the denial of payer preauthorization. The CTCA-MAP appeals payer denials, and simultaneously coordinates applications to patient assistance programs. Each payer appeal is customized to the patient's disease profile and unique tumor genomics and is based on any available evidence supporting the therapy’s use and safety in the patient’s tumor type. Results: A total of 825 patients (338 males and 487 females; median age 57 years) were enrolled into the program from October 2015 to October 2020. The most common tumor types were breast (n = 157), colorectal (n = 96), pancreas (n = 72), lung (n = 68), ovarian (n = 35) and prostate (n = 35). 682 (82.7%) patients were able to access therapy through patient assistance programs (n = 548), overturned payer appeals (n = 133) or conversion from patient assistance to insurance (n = 1) within a median of 16 days from the date of program referral. Only 5 (0.6%) patients were unable to access therapy through payer appeals or philanthropic programs. The remaining 138 (16.7%) patients could not complete the program due to disease progression or death. The overturned payer appeals led to insurance coverage for an estimated USD 7.95 million in drugs (calculated as the multiplication of drug cost per cycle and the number of cycles received). Conclusions: The CTCA-MAP provides a mechanism through which cancer patients with potentially actionable genetic variants can acquire access to existing off-label targeted therapies when standard-of-care is no longer effective, or when they are ineligible for a clinical trial. This program's outcomes to date demonstrate a need for a concerted advocacy effort to increase accessibility for cancer patients to these innovative targeted therapies.

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Transparency of Industry-Sponsored Oncology Patient Financial Assistance Programs Using a Patient-Centered Approach

Journal of Oncology Practice ◽

10.1200/jop.2016.017509 ◽

2017 ◽

Vol 13 (3) ◽

pp. e240-e248 ◽

Cited By ~ 7

Author(s):

S. Yousuf Zafar ◽

Jeffrey Peppercorn ◽

Akwasi Asabere ◽

Alex Bastian

Keyword(s):

Web Sites ◽

Free Drug ◽

Financial Assistance ◽

Oncology Patient ◽

Assistance Program ◽

Specific Patient ◽

Assistance Programs ◽

Average Maximum ◽

Patient Assistance ◽

The Impact

Objective: Pharmaceutical manufacturers sponsor drug-specific patient assistance programs that provide eligible patients with financial assistance, either in the form of providing the drug free of charge or copayment assistance. Describing these programs and determining who receives assistance is an important first step in understanding the impact and role of financial assistance in cancer care. Our objective was to describe eligibility criteria and benefits for cancer-specific, manufacturer-sponsored patient assistance programs. Methods: We conducted a prospective review of patient assistance program Web sites and called patient assistance program telephone hotlines from the perspective of a patient or caregiver requesting program details. Results: We identified 24 manufacturers with patient assistance programs, covering 87% of Food and Drug Administration–approved oncology drugs. For free drug programs, the average maximum annual income for qualification was $86,279. For copayment assistance programs, the average was $104,790. Thirty-five percent of free drug programs and 53% of copayment assistance programs declined to provide details on how financial need was determined. None of the programs shared details on patient usage statistics. Conclusion: Variation exists in the quality and quantity of data available to patients seeking financial assistance for cancer treatment via manufacturer Web sites and hotlines. Greater transparency among patient assistance programs would enhance utility for patients and help to determine the net impact on costs and adherence.

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Addressing Pain Control in Low-Income Cancer Patients: One Hospital's Innovative Pilot Program Finds Pharmaceutical Patient Assistance Programs Lacking

Oncology Issues ◽

10.1080/10463356.2005.11883275 ◽

2005 ◽

Vol 20 (6) ◽

pp. 36-39

Author(s):

Etienne Phipps ◽

Judith Quinn ◽

Nora Madison-Thompson ◽

Sherry Pomerantz ◽

Joann Ackler ◽

...

Keyword(s):

Cancer Patients ◽

Low Income ◽

Pain Control ◽

Pilot Program ◽

Assistance Programs ◽

Patient Assistance

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Development of a systematic approach to pharmaceutical industry’s patient assistance programs on accessing unfunded cancer drugs

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155216677854 ◽

2016 ◽

Vol 24 (1) ◽

pp. 18-21 ◽

Cited By ~ 1

Author(s):

Victoria Kletas ◽

Mario de Lemos

Keyword(s):

Drug Information ◽

Public Funding ◽

Pharmaceutical Companies ◽

Care Organization ◽

Publicly Funded ◽

Cancer Drugs ◽

Assistance Program ◽

Assistance Programs ◽

Patient Assistance ◽

Set Up

Background New oncology drugs usually become commercially available several months before the funding decisions are made by provincial public payers. Increasingly, patient assistance programs are being set up by pharmaceutical companies in order to facilitate access of their new cancer drugs before public funding decisions are finalized. We discovered that there is a need to keep this information up to date and available in a central repository, thus we have created a centralized patient assistance chart for use by all who require information on accessing unfunded drugs in our province. Methodology The project was carried out at a publicly funded provincial cancer care organization that oversees parenteral and oral chemotherapy treatments across our province. The drug information pharmacist at this organization developed a method of scoping information on upcoming therapies by reviewing a series of recommendations made by various organizations that review oncology treatments. A standard process was developed for including information on the patient assistance chart that is available on the organizations website. Results As of May 2016, the repository contains information on 47 patient assistance programs involving 24 unfunded antineoplastic drugs for various indications. This compared to (7) when it was maintained by a single centre in 2004 and 10 when the process was first centralized in 2009. Conclusion The benefit of patient assistance program availability allows patients to access medications when provincial funding is not available. A standardized approach and methodology to evaluating information was established by our drug information pharmacist; thus allowing for a consistent approach to dissemination of information on assessing unfunded cancer drugs in our province.

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Cost of comprehensive patient assistance program in early breast cancer patients

SpringerPlus ◽

10.1186/2193-1801-2-173 ◽

2013 ◽

Vol 2 (1) ◽

Cited By ~ 2

Author(s):

Anne M Stey ◽

Kezhen Fei ◽

Rebeca Franco ◽

Ali Mendelson ◽

Nina A Bickell

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Early Breast Cancer ◽

Breast Cancer Patients ◽

Assistance Program ◽

Patient Assistance

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Patient Assistance Programs and Technology in Medication Adherence

INNOVATIONS in pharmacy ◽

10.24926/iip.v11i2.3269 ◽

2020 ◽

Vol 11 (2) ◽

pp. 9

Author(s):

Carlos Colon ◽

Raiza Cotto ◽

Militza Diaz ◽

Isabel Martinez ◽

Paulette Salas ◽

...

Keyword(s):

Medication Adherence ◽

Medication Management ◽

Assistance Program ◽

Assistance Programs ◽

Disease States ◽

Lower Education Level ◽

Patient Assistance ◽

Quasi Experimental ◽

Care Assistance ◽

The Impact

Background: Patient assistance programs, including medication management and counseling, have the potential to improve care in chronic disease states with complex therapies. Incorporating technology as a tool to foster adherence is becoming more commonplace in practice. Objectives: The purpose of this report is to identify barriers of medication adherence and review the impact of patient assistance programs and technology on medication adherence. Methods: A literature search was conducted in secondary databases, PubMed/MEDLINE and EBSCOhost of peer-reviewed systematic reviews, experimental, quasi-experimental, and observational reports published in English within the last fifteen years. Terms searched included patient assistance program, pharmacist role, technology, adherence or compliance, income and health. Results: Ten studies met our prespecified criteria. Male sex, several self-reported chronic diseases, negative expectancy of treatment, engagement in polypharmacy, financial hardships and lower education level correlated with lower medication adherence. Patient care assistance programs and utilization of technology (e.g., use of a mobile application) improved medication adherence. Conclusions: Patient assistance programs and technological tools, such as mobile applications, are necessary resources in improving medication adherence. Article Type: Idea Paper

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