The role of patient financial assistance programs in reducing costs for cancer patients

Abstract

BACKGROUND: Limited transparency exists regarding eligibility and benefits for patient financial assistance programs (PAPs). OBJECTIVE: To describe oral anticancer medication costs, insurance coverage, and the degree of financial assistance provided by PAPs. METHODS: This was a retrospective study of prescription anticancer medication costs and PAP coverage. The study used data from an academic cancer center's specialty pharmacy. Medication, cost, and coverage data were collected from the specialty pharmacy database for prescriptions filled from January 2013 to November 2015. Prescriptions with missing copayments, insurance, or financial assistance amounts were excluded. Descriptive statistics summarized prescription characteristics. RESULTS: Of 9,388 anticancer medication prescriptions filled, 8,212 (87[%]) had complete cost data and were included. The 5 most common medications prescribed were capecitabine (20[%]), temozolomide (13[%]), enzalutamide (10[%]), letrozole (6[%]), and tamoxifen (4[%]). Most prescriptions were covered by commercial insurance or Part D (41.6[%], n = 3,418). The median copayment was $20 per prescription (interquartile range [[]IQR] = $10.00-$80.30). When considering all prescriptions that received PAP assistance, the median amount of financial assistance provided by PAPs per prescription was $411.0 (IQR = $302.80-$523.40), amounting to 15[%] of the median prescription cash price. When considering all prescriptions, the median amount of financial assistance provided by PAPs per prescription was {Abstract_Foreign_Lang}, and the mean was $79.30 (SD = $389.90). CONCLUSIONS: A minority of prescriptions received financial assistance from PAPs. The proportion of financial assistance was small relative to the price billed to insurance. PAPs play a modest role in reducing anticancer prescription-related costs.