Editor’s note: A version of this article appeared in the August 2022 issue of Conquer Magazine.
Five years ago, when I was working as a financial navigator at a community cancer center in Michigan, a breast cancer patient entered my office with an all-too-familiar dilemma. She had recently started treatment and was struggling with the physical effects of chemotherapy. She was also dealing with the emotional toll of her diagnosis, which was not only weighing on her but also on her partner and their three young children. But her most urgent concern was how she and her family could afford the astronomical costs of her care. Her chemotherapy drugs alone cost more than $50,000 per dose. Between medication, travel to and from our facility, and other expenses—as well as lost income due to her inability to work—the financial burden had become unmanageable. She faced a decision no one should have to make: Should she pay for necessary living expenses, including her family’s mortgage, food, and childcare, or pay for lifesaving treatment?
This patient is not alone in her struggles. Breast cancer has the highest cost of care among all cancer types, and the tremendous economic burden is expected to grow. By 2030, the annual costs associated with metastatic breast cancer are projected to be $152.4 billion — nearly 2.5 times higher than costs in 2015.
The financial toll of cancer often leads to significant lifestyle changes for patients, and even influences treatment decisions. 47% of breast cancer patients report costs of care as a significant or catastrophic burden. In a recent study, 43% of women considered costs when making treatment-related decisions, and 28% reported that treatment costs influenced their decisions regarding breast cancer surgery.
Patients with cancer who experience financial hardship are at a high risk of treatment nonadherence, leading to high levels of emotional distress, lower quality of life, and higher mortality rates. Fortunately, financial navigators can play a critical role in helping breast cancer patients avoid financial toxicity.
Four Ways to Help Breast Cancer Patients
Here are four ways to ensure patients have the benefits and funding they need to afford care:
1. Make Sure Patients’ Insurance is Optimized
No matter what type of insurance a patient has, the first step in working with patients is to evaluate their existing coverage and out-of-pocket maximum. From there, we have the opportunity to educate patients on ways to optimize their coverage, whether that’s by changing their plan or adding a supplemental plan to their existing coverage.
Patients with Medicare coverage may want to get on a supplemental plan or apply for a Medicare Savings Program, also known as Extra Help. This federal program provides support for prescription drug premiums, deductibles, and cost-sharing for eligible patients with annual incomes at 150% of the federal poverty level.
With the passage of the Inflation Reduction Act, patients can expect to find more aid and lower premiums for Affordable Care Act (ACA)-compliant plans on the Marketplace compared with years past. This legislation has a number of provisions that will allow individuals and families to save on healthcare costs, including premiums, prescription drugs, coinsurance, and copays.
2. Explore Patient Assistance Programs and Funds
Financial navigators can alleviate some of the stress breast cancer patients feel by explaining financial support options, including copay assistance programs, charitable foundations, disease-specific funds and drug manufacturer programs.
The Patient Advocate Foundation and the Patient Access Network Foundation, for example, provide copay grants on a first-come, first-served basis to breast cancer patients who meet specific medical and financial criteria.
Since foundation funds tend to close quickly, it’s important to track which funds are available and when, and get permission from the patient to apply for funds on their behalf. Some funds have a wait-list, but many provide retroactive reimbursement once patients are enrolled in the program. For example, CancerCare’s Assistance Fund considers retroactive payments for patients who are actively receiving breast cancer treatment or have received treatment within 60 days of their approval.
Drug manufacturer assistance programs may provide free or low-cost medications to patients who have no third-party insurance coverage. If the health system you work for has internal funds, these may be used to help alleviate financial toxicity for patients with and without insurance coverage.
3. Beyond Treatment: Helping Patients Get Help with Living Expenses
Many breast cancer patients, like the woman I worked with in Michigan, struggle to cover their general living expenses after paying for medication and treatment. For these patients, there are organizations that provide funding to cover costs such as transportation, childcare, mortgage and rent, utilities, and groceries.
Pink Fund, for example, provides 90 days of nonmedical expenses to breast cancer patients in active treatment. The Susan G. Komen Foundation’s Komen Treatment Assistance Program provides funding for daily living expenses to breast cancer patients who meet the program’s eligibility criteria. The Provision Project offers financial relief to patients in active treatment for breast cancer, so no family is ever put in the impossible predicament of choosing between lifesaving cancer care and day-to-day expenses. For more resources, check out this guide compiled by the Mesothelioma Center.
Depending on where your patient lives, there may be local, regional, and community-based assistance programs for breast cancer patients that may help cover treatment-related costs or provide support in paying daily living expenses and/or providing meals.
4. Encourage Patients to Lean on the Family Medical Leave Act and Other Government Protections
Breast cancer patients who are employed may be concerned about loss of income and insurance coverage if they take time off from work to undergo treatment. Loss of employment increases the risk of financial toxicity, which is associated with a lower quality of life, higher symptom burden, emotional distress, and lower treatment adherence.
Financial navigators can provide peace of mind by assuring patients that there are protections in place, such as:
- Family and Medical Leave Act (FMLA): Eligible employees can take up to 12 weeks of unpaid leave for medical reasons. It may be helpful to remind patients that the 12 weeks don’t need to be taken all at once; leave can be intermittent.
- Short- and long-term disability plans: Offered by some employers, these plans provide a continuation of income and benefits for medically disabled employees.
- Social Security Disability Insurance (SSDI): Provides a monthly income for patients who have worked and paid Social Security taxes on their earnings in the last 10 years.
- Consolidated Omnibus Budget Reconciliation Act (COBRA): Gives workers the right to continue to receive benefits from their employers’ health plan for a limited period. Patients who opt for COBRA are required to pay the entire premium for coverage up to 102% of the cost of the plan. Disease-specific funds such as The HealthWell Foundation, offers funding for insurance premiums to assist eligible breast cancer patients.
Explore All Available Assistance–and Streamline the Process
By optimizing patients’ insurance, exploring funding to offset their medical and living expenses, and encouraging them to lean on government protections, financial navigators can ease the financial burden of breast cancer.
Research shows that patients who work with financial navigators have an increased quality of life, lower stress levels, improved treatment adherence and higher survival rates. It is clear that financial navigators offer significant support for patients, but time limitations due to the manual nature of much of the work can make it difficult to serve every patient in need.
Just as newly developed medical technologies have advanced our approach to breast cancer diagnosis and treatments, financial navigation technology can increase efficiencies and improve access to care. Software solutions enable navigators to proactively flag patients in need, match them with available funding, and automate enrollment in cost-saving resources.
Financial navigators can and should use every tool at their disposal to ensure more breast cancer patients get the assistance they need, so that they can focus on what matters most: their treatment and recovery.