Month: March 2022

The Inaugural Survey of Infusion Copay Cards

The Inaugural Survey of Copay Manufacturer Programs

Q Consulting Support Services conducted a survey of infusion center staff who work regularly with copay programs and after tabulating all of the responses, have come up with the Top-10 Manufacturer Copay Assistance Programs based on five criteria.

The easy winner was Jannsen Carepath, who had the top score in all categories except for one. At the bottom was Zoladex, who failed on most levels, but was particularly weak when it came to the ability to secure payments.

1. Ease of Copay Card Enrolment

The winners of this segment all had two key ingredients

1. Online ability to submit information for approval – particularly via a portal
2. Immediate Notification of approval

Most of the manufacturers have a portal program or other online programs.

The two programs that performed poorly in this category was Pfizer enCompass, which requires a paper submission via fax and was described as ‘frustrating’ to almost all respondents. The Merck Access Program was also at the bottom of this group with respondents noting that ‘it can take as long as a week to receive notification of approval into the program’.

Several comments were also made regarding Amgen’s First Step program which received comments like “a great online service with immediate notification of approval” but the ‘requirement of a social security number make it difficult for staff to easily sign up the patient’ as this information isn’t something that always sits at their fingertips.

2. Ease of Copay Claim Submission

A portal is the preferred method of submitting the Explanation of Benefits, and other items that copay manufacturer programs request. Janssen is the clear winner and the only one to score a perfect score for this category.

The bottom of the pile for this category was Zoladex and most comments revolved around how many times a fax needed to be submitted – “in multiple follow-up calls to check on status, they always tell us that the full fax wasn’t received and another one needs to be resubmitted”.

Another weak performer in this group was Coherus Complete whose fax number is frequently busy and requires multiple attempts before a fax makes it through. It took one respondent 2-days of trying before the fax was finally accepted

3. Time to Copay Approval

With the exception of Zoladex (which can take over a month), most copay manufacturer programs have between a 3 and 7-day approval timeframe. Again, portals are preferred as the user can check on the status of the approval without having to call for status updates.

4. Notification of Copay Payment Approval

This is where the portal was strong again – being notified immediately via the portal was the preferred method. However, Amgen FirstStep scored high marks, despite receiving notifications via fax, because the notification includes the details of the payment and whether it is being made by check (for which they include the check number) or copay card (for which they include the credit card number and CVC#.)

Many of the others really require constant follow-up for approval details, which was a big frustration to the survey respondents.

5. Customer Service

In general, every copay card assistance program has excellent customer service, with representatives that are very knowledgeable and helpful. Entyvio and Janssen lose one star here because the representatives have struggled occasionally with questions – particularly as it relates to the portal.

About Q Consulting Support Services

Copay Assistance Programs lessen the patient’s financial burden, making it easier for them to obtain their prescription and ensure that the appropriate treatment is attainable.

Q Consulting Support Services specializes in the management of Copay Card programs. Our dedicated staff partners with clients ranging from small oncology practices to the country’s largest healthcare systems. Our Support Service team enrolls the patient into the Copay Card Program, monitors and submits EOBs with patient out-of-pocket expenses, and follows up on any denials to ensure payment is received promptly. Ultimately, increasing patient satisfaction and reducing the financial burden on the provider’s office or facility by guaranteeing patient out-of-pocket expenses are obtained, which reduces bad debt and increases revenue.

CONTACT US TO LEARN MORE

A quick-reference guide for oncology practices to identify cancer patients at risk of financial toxicity.

• Financial Toxicity of Cancer Treatment & Survivorship.pdf

Risk Factors for Cancer Patient Financial Toxicity

Financial toxicity is how the healthcare industry has come to define the financial hardship that patients experience due to their high out-of-pocket costs.

Age: Patients Who Are Less Than 65 Years of Age

Age is one of the biggest risk factors in determining the financial burden of treatment. Cancer patients that are less that 65 years old are more likely to be financially impacted by treatment than those who are 65 and older. Why?

1. <65 Years Old is Working Age

Cancer treatment requires frequent days away from work due to therapy. Chemotherapy infusion times can be as lengthy as 4 to 8 hours long. The patient also has to deal with the treatment-related side effects that decrease their work hours and overall productivity.

2. Lack Savings and Assets

Younger cancer patients are vulnerable to financial distress because of a lack of savings and assets that are accumulated during working-age

3. Other Financial Obligations

Cancer patients that are <65 years old have other financial responsibilities such as childcare, education, mortgage/rent, and high household expenses associated with raising a family.

4. Lack Insurance or Carry High-Deductible Plan

Younger cancer patients lack the protection of Medicare. Decreased work hours reduces employment based insurance options, placing some without insurance or with high-deductible plans.

How Your Practice Can Help Its Cancer Patients

At Q Consulting Support Services, we provide the strategy, workflows and technology needed to obtain a more comprehensive picture of the patient’s financial status and find solutions to their financial toxicity burden. Our successful system decreases the patient’s out-of-pocket responsibility and reduces bad medical debt through unconventional patient funding sources. We can fill in the gaps through patient financial advocacy, so patients feel taken care of physically and financially to drive up patient satisfaction scores.

Financial Advocacy Programs assist hospitals, infusion centers, and cancer care clinics gain access to financial assistance for oncology patients to cover unaffordable out-of-pocket expenses to reduce the treating institution’s bad debt and improve patient satisfaction.

Patients with cancer often face financial hardships or financial toxicity, including loss of productivity, high out-of-pocket (OOP) expenses, depletion of savings, and bankruptcy. Providing financial guidance and assistance through specially trained financial advocates allows hospitals, infusion centers, and cancer care clinics to mitigate the financial burdens on patients and minimize financial losses for the treating institutions.

Financial Toxicity

After a cancer diagnosis, patients and their families face many stressors, including significant short-term and long-term financial consequences. Rising insurance premiums, deductibles, coinsurance, and co-payments are directly responsible for the rising OOP costs. The combination of direct and indirect costs related to patients’ and families’ decreased work hours, or loss of employment creates a perfect storm for financial toxicity.

Many studies have shown that patients with cancer who experience financial hardship have a higher risk of treatment nonadherence, inferior quality of life, and higher mortality than those who do not experience such hardship. Thus, further supporting the desperate need for financial advocates to help mitigate the financial burden of cancer treatment.

Types of Assistance provided by Financial Advocates

Manufacturer Copay assistanceDrug Manufactures offer Copay Card assistance programs. The program’s purpose is to help patients with commercial or private insurance cover their deductibles, copays, and coinsurance directly related to their prescription drugs’ cost. Cost savings from copay assistance is paid directly to the treating institution via check or credit card. As a result, copay assistance reduces the patient’s balance and allows them to focus on adhering to their treatment plan rather than focusing on the financial burden associated with cancer treatment. In addition, the treating institution’s revenue increases by collecting the OOP expenses typically written off as bad debt.Copay Assistance through Private FoundationsFoundations offer financial assistance to those suffering from chronic or life-altering diseases when insurance coverage is insufficient. Foundations help fill the gaps by assisting patients with their out-of-pocket expenses. Medicare patients will not qualify for Manufacturer Copay Assistance Programs; however, they may be eligible for coverage through a foundation. OOP expenses generally covered through foundation assistance include oral and infusion drug costs, radiation, and blood transfusions. Copay assistance through the foundation is paid directly to the treating institution and increases revenue that otherwise would have gone to bad debt.Premium Assistance through Private FoundationsSome foundations will also cover the patient’s insurance premiums. Premium assistance allows us to help cover OOP expenses the patient has incurred that the foundation does not cover. Utilizing this benefit will ultimately reduce the patient’s balance and reduce the treating institution’s bad debt.Urgent Need Assistance through Private FoundationsAnother type of assistance provided by private foundations is urgent need and travel assistance funds. These funds open quickly and generally award smaller amounts of $250 or $500 for patients to use towards their mortgage, utility bills, transportation costs, and food. This benefit provides financial relief to patients facing hardship by covering some of their living expenses, so they do not have to choose between groceries that week or paying for their oral oncology medication.Free medication – Patient Assistance Programs (PAPs)This type of assistance helps those in need obtain their medications at no cost or very low cost. Many, but not all, pharmaceutical companies offer PAPs. Pharmaceutical companies provide free medication for oral oncology drugs delivered directly to patients or infusion oncology drugs supplied to hospitals on the patients’ behalf. Free medication is typically the last option chosen when sourcing financial assistance to patients. This option does not directly benefit the treating institution’s revenue. However, in both cases, the benefit to the hospital and the patient is minimizing bad debt collection due to unaffordable OOP expenses.

Communicating with Financial Advocates

Before beginning treatment, communication about treatment costs is key to addressing the patients’ and families’ financial issues. Treating institutions benefit greatly from collaboration with outside organizations, like Q Consulting Support Services (QCSS), with expertise in financial counseling and medical costs. Q Consulting financial advocates work alongside the treating institution’s clinical staff to increase the communication with the patient’s about their cost of treatment and how we can assist in reducing their OOP expenses.

Unfortunately, communication of treatment cost frequently falls on poorly trained staff who do not have the required education or credentials to offer true expertise in dealing with the complexities of insurance plans, treatment-related costs, and finding and sourcing financial assistance. Therefore, a high need exists to establish a relationship with advocates that can assist patients with the benefits of different types of oncology financial assistance options.

Impact of Hiring Financial Advocates

Q Consulting Support Services provides a team of highly trained advocates to identify, source, and manage the much-needed financial assistance available to oncology patients. We improve patient access to financial assistance through a systematic process for identifying patients in need and notifying them of the help available. We then obtain consent from patients, apply for financial assistance on their behalf and fully manage the entire process from claim submission to the treating institution receiving payment. QCSS utilizes proprietary software that allows us to manage the whole process seamlessly. In addition, patients are updated every step of the way and have complete access to our financial advocates to answer any questions during treatment.

By instituting a financial advocacy program through QCSS using trained financial advocates, hospitals, infusion centers, and cancer care clinics can save money that would typically have gone to bad debt. As a result, patients can gain access to care that would otherwise have been unaffordable, and overall patient satisfaction increases.

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