Financial navigator: Raylena Carbone

Diagnosis: Prostate cancer

Type of healthcare organization: Infusion center

Medication: Lupron and Xtandi

Assistance program: The Assistance Fund (TAF)

Costs covered: $3,300 per month for Xtandi / ~$200 per Lupron injection every six months

Patient financial responsibility with assistance: $0

TailorMed financial navigator Raylena Carbone helped a patient with prostate cancer afford essential care. The patient was struggling to pay for two medications, Xtandi, an oral medication, and Lupron, an infusion therapy. He was insured through a Medicare Advantage plan, so Raylena decided to explore foundation grants to assist with his out-of-pocket costs. “When I first reached out, the patient had no idea these resources existed,” Raylena said. “I explained what foundation grants were and how they worked.”
After identifying a foundation with an open fund, Raylena walked the patient through the process of applying and enrolling. Unfortunately, Raylena and the patient learned that he was not eligible because his income was slightly above the limit. “I could hear the disappointment in his voice,” Raylena said.

Determined to find another resource, Raylena added the patient to the waiting list for another foundation, The Assistance Fund (TAF). “I told him, ‘This fund has a higher limit, and if it opens, you would qualify,” she recalled.

Soon afterward, the patient called Raylena to share the good news: TAF alerted him that the fund had reopened and he was approved for copay assistance. “He called me and said, ‘I just wanted to thank you for getting the ball rolling,’” Raylena said. “He was so thankful as they reimbursed him for the $3,300 he paid for his oral medication. We were also able to apply this grant to his infusion treatment.”

The grant does not have a cap, meaning that TAF covers the patient’s medication costs until the grant expires–in this case, at the end of the year. Thankfully, Raylena was able to discuss re-enrollment at the end of 2024, ensuring his coverage would continue throughout 2025.

Without the grant, the patient would have paid $3,330 per month for Xtandi and about $200 every six months for Lupron injections–expenses that would have quickly added up.

“I don’t think many patients realize these programs are out there,” Raylena said. “It’s amazing how much you can help just by reaching out. Even a small grant can make a big difference.”

Interested in partnering with our TailorMed Complete team to optimize financial assistance and reach more patients? Contact us to learn more.