Cost-Sharing Roundtable: Sustainable Strategies for Providing Access to Critical Medications

As new therapies come to market, there is the good news that patients are cured or living longer, but it has to be balanced by the bad news that these treatments are far more expensive, said Paul Billings, senior vice president advocacy for the American Lung Association.

Beyond helping with co-payment assistance for patients with cancer, CancerCare helps with practical and emotional supports for patients, explained Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation.

M. Kristina Wharton, MPH, of the Department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine, recommends shifts in policies that could expand federally qualified health centers.

Unlike commercial plans, Medicare beneficiaries run the risk hitting the donut hole, which causes their costs to go up dramatically, said Paul Billings, senior vice president advocacy for the American Lung Association.

There are financial burdens related to cancer treatment other than the cost of medication, but patients don't always realize that when they are first diagnosed, explained Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation.

Charitable organizations are seeing more and more patients who need financial assistance, said Dan Klein, President and CEO, Patient Access Network (PAN) Foundation.

Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation, recognizes the financial hardships of cancer patients when paying for medications.

While use of services at federally qualified health centers has increased particularly since the implementation of the Affordable Care Act, the increasing trend started back in 2002, said M. Kristina Wharton, MPH, of the Department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine.

Dan Klein, president and CEO of the Patient Access Network (PAN) Foundation, discusses the need for more patient assistance foundations to help patients pay for treatment.

Leigh Purvis, director of Health Services Research at AARP Public Policy Institute, addresses the burdens of high prescription drug costs on Medicare beneficiaries.

The high cost of new, innovative cancer treatments coming to market makes these therapies inaccessible to a lot of patients, said Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation.

In order to make Medicare drug price negotiation a reality, the government has to have additional leverage to negotiate that it doesn't have, explained Ed F. Haislmaier, the Preston A. Wells Jr senior research fellow at the Institute for Family Community, and Opportunity at The Heritage Foundation.

Providing financial navigators in cancer centers and hospitals can have demonstrable benefits for both patients and hospitals, explained Todd Yezefski, MD, senior fellow in the Clinical Research Division at the Fred Hutchinson Cancer Research Center and Division of Medical Oncology at the University of Washington.

M. Kristina Wharton, MPH, of the Department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine, talks about the services federally qualified centers provide, specifically how they help patients access medications.

Dan Klein, president and CEO of the Patient Access Network (PAN) Foundation, lists possible policy changes that would strengthen the safety net.

Government programs, especially Medicare, are stuck in the past and are not designed to accommodate advancements in modern technology, said Ed F. Haislmaier, the Preston A. Wells Jr senior research fellow at the Institute for Family Community, and Opportunity at The Heritage Foundation.

Leigh Purvis, director of Health Services Research at AARP Public Policy Institute, discusses future policies that will relieve Medicare beneficiaries from some of their expensive out-of-pocket costs.

A clear majority of patients with cancer experience some sort of financial hardship, and the cost of care is something that weighs on the minds of patients and their families right from the moment of diagnosis, said Todd Yezefski, MD, senior fellow in the Clinical Research Division at the Fred Hutchinson Cancer Research Center and Division of Medical Oncology at the University of Washington.

Patients benefiting from federally qualified health centers tend to be sicker than the general population, but there are also disparities by state, explained M. Kristina Wharton, MPH, of the Department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine.

High costs in cancer care not only affects treatment outcomes for patients, but also their overall quality of life, explained Michele McCourt, senior director of the CancerCare Co-Payment Assistance Foundation.

Dan Klein, President and CEO, Patient Access Network Foundation, discusses how the lack of a limit on cost sharing in Medicare affects patient outcomes and disease states that PAN Foundation is keeping an eye on.

Ed F. Haislmaier, the Preston A. Wells Jr senior research fellow at the Institute for Family Community, and Opportunity at The Heritage Foundation, talks about the impact of new business partnerships on healthcare costs.

The burden of high drug costs is something that everyone with health insurance coverage is facing, explained Leigh Purvis, director, Health Services Research, AARP Public Policy Institute.

Ed F. Haislmaier, the Preston A. Wells Jr senior research fellow at the Institute for Family, Community, and Opportunity at The Heritage Foundation, discusses the policies under the Trump administration and how they will affect financial burdens.

Financial navigator programs in hospitals take commitment and money to start up, but they more than pay for themselves, said Todd Yezefski, MD, senior fellow in the Clinical Research Division at the Fred Hutchinson Cancer Research Center and Division of Medical Oncology at the University of Washington.

Elected officials and others who affect policy know that cost-sharing and out-of-pocket costs are issues in healthcare, but they don’t truly understand the issues, said panelists during a policy discussion on ways to improve access and reduce financial hardship during the Cost-Sharing Roundtable.

Experts from healthcare policy organizations and advocacy groups that cater to Medicare enrollees exchanged best practices and proposed policies to help alleviate access issues during the Cost-Sharing Roundtable, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®, on February 23, 2018, at the Barbara Jordan Conference Center in Washington, DC.

Healthcare cost-sharing remains a significant barrier to healthcare access, especially among patients with chronic conditions or those with financial constraints, and could prevent patients from getting much-needed health services, use of diagnostic tests, or result in adherence issues due to patients skipping doses or not filling their prescription medications. At the Cost-Sharing Roundtable on February 23, 2018, presenters and panelists—from academic institutions, health policy organizations, and charitable foundations—shared their findings and experiences with financial hardships faced by patients, and brain stormed ideas on how best to address the situation via practical advice and policy changes.

Leaders from charitable organizations that provide the safety net so patients can meet their healthcare costs and access their required medical treatment have concerns with the widening gap between patient financial needs and available resources. They were speaking at the Cost-Sharing Roundtable in Washington, DC, co-hosted by the Patient Access Network Foundation and The American Journal of Managed Care®.

Federally qualified health centers pay an important role in providing primary care and preventive services for patients who may have trouble accessing this care because of their insurance status, explained M. Kristina Wharton, MPH, of the Department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine.