In healthcare, the term “financial toxicity” is typically associated with high-cost cancer treatments, which is likely why so many financial navigation programs focus on people with cancer. Indeed, 97% of cancer centers offer some type of financial assistance, according to a survey conducted by the National Cancer Institute in 2019.
But financial toxicity isn’t just a cancer problem. There’s no denying that cancer treatment can be prohibitively expensive, and that many patients need financial support to afford it. But for every oncology patient eligible for assistance, there are hundreds (if not thousands) more patients with costly chronic conditions who are struggling to pay for treatment—and they need help accessing available resources.
Healthcare organizations that focus financial navigation efforts only on cancer patients are missing out on opportunities to help seriously ill people find assistance. The support is out there, but organizations can’t offer it to their patients if they’re not aware of it.
Five Costly Health Conditions
Here are five of the most costly health conditions according to recent CDC data, along with an overview of the different types of financial support available for patients. Unfortunately, these five are only the tip of the iceberg when it comes to conditions that can cause financial toxicity.
1. Heart disease and stroke
Heart disease and stroke are the leading causes of death in the United States, with more than 877,500 Americans dying from these diseases every year. So it’s not surprising that the annual costs associated with heart disease and stroke are staggering—$216 billion in direct medical costs and $147 billion in lost productivity, for a total of $363 billion per year.
2. Diabetes
About 11% of Americans have diabetes, and a whopping 38% have prediabetes, according to the CDC. Couple the pervasiveness of this condition with the fact that it is often accompanied by severe health complications such as heart disease, blindness, kidney disease, and amputations, and you end up with healthcare costs of $327 billion.
3. Arthritis
About one in four adults in the U.S. have arthritis, a chronic condition that can be as costly as it is painful. Arthritis is a leading cause of work disability, and results in $164 billion in lost productivity every year. Added to the $140 billion in direct medical costs, this adds up to an estimated $304 billion in total costs every year.
4. Alzheimer’s disease
More than six million Americans have Alzheimer’s disease—a number that is projected to double by 2050 as the population of people aged 65 and older continues to grow. In addition to costing $305 billion for long-term and hospice care in 2020, the amount of unpaid care provided to people with Alzheimer’s in 2019 was valued at approximately $244 billion.
5. Epilepsy
About one in 100 Americans is living with epilepsy, and it’s estimated that one in 26 will develop the condition in their lifetime. While seizures are the hallmark symptom of epilepsy, patients often deal with other health challenges such as depression related to the disease. Epilepsy costs the U.S. $8.6 billion every year. While generic epilepsy drugs have become increasingly available, brand-name drug prices have continued to climb, causing affordability challenges for patients.
Types of Financial Assistance
Once healthcare organizations understand that cancer isn’t the only condition that causes financial distress, the next step is to gain awareness of various types of assistance and develop a systemwide process to ensure patients with other diagnoses have access to them. Financial navigation programs should be implemented wherever prescriptions are written or dispensed, whether a patient is coming to an infusion center, a clinic, or any other part of the health system.
Here are some of the resources available to patients with many high-cost, chronic conditions:
Drug manufacturer copay assistance programs help patients with high-cost conditions pay for deductibles, copays, and coinsurance. Pharmaceutical manufacturers offer copay assistance in the form of discount programs for prescription drugs.
They provide coupons that patients can take to their pharmacy when filling their prescriptions, or patients can apply the coupon toward their insurance company’s annual cost-sharing requirement. Patients must have commercial insurance, not government-funded insurance, to qualify for these programs.
Foundation assistance comes from charitable organizations such as HealthWell, PAN, and The Assistance Fund. These nonprofits (and many others) offer grants to assist with copays, premiums, and living expenses to patients with commercial as well as government-funded insurance, including Medicare, Medicaid, and military benefits. These funds are often disease-specific and cover dozens of conditions.
Free and replacement drug programs are another assistance option offered by pharmaceutical companies. These programs provide medications at no cost to patients in need.
Participants are typically patients without insurance who wouldn’t otherwise be able to afford their medications, but insured patients may also be eligible if, for example, they have Medicare but a high out-of-pocket limit, or they have Medicare Part D with a high copay.
Government assistance programs can help people with Medicare cover their high-cost treatments. These include State Health Insurance Assistance Programs (SHIPs) and the Social Security Administration’s Extra Help program, which is designed for Medicare beneficiaries who need help paying their monthly premiums, annual deductibles, and copays related to Medicare prescription drug coverage.
Some states also have State Pharmaceutical Assistance Programs that can help people with certain medical conditions who need assistance.
Hospital charity programs are another possibility for financial support, since the Affordable Care Act made it a requirement that nonprofit hospital organizations offer assistance to people who can’t afford care.
Organizations are legally obligated to explain the details of these Financial Assistance Programs (FAPs), including the application process, but patients may find the process difficult to navigate without expert guidance.
This is partly because eligibility requirements vary from state to state; the threshold for eligibility for free care is a household income below 100% of the federal poverty level (FPL) in Washington state but 200% in New Jersey and Massachusetts, for example.
Harnessing Technology to Reduce Financial Toxicity
For those with chronic conditions, access to treatment is often a matter of life and death, yet affordability challenges create access barriers. Platforms like TailorMed allow providers and pharmacies to proactively identify patients in need before they slip under the radar and face a bill they can’t afford.
Technology solutions then produce a curated list of resources and automate the enrollment process, eliminating the need for spreadsheets and cumbersome paperwork. This saves organizations time and money, while giving patients what they need most: the ability to afford care.
High-Cost Conditions Require Extra Care
High-cost conditions such as the five outlined above can take a tremendous physical and mental toll on the people who are living with them—especially when they’re struggling to pay for treatments they desperately need. With the help of technology, financial navigators, advocates, and other professionals can guide patients through the complex process of overcoming barriers to care and maximizing assistance opportunities.
