November 2014 Edition Vol.11, Issue 11

Patient Affordability: The Most Important Non-Clinical Attribute in Choosing Between Treatment Options

Patient Affordability: The Most Important Non-clinical Attribute In Choosing Between Treatment Options (continued)

Affordability Affects Treatment Decisions

Oncologists have taken notice of their patients’ escalating financial burden. In a recent Kantar Health survey, more than half of oncologist and practice manager respondents noted an increase in patient concern about cost compared to a year ago. Further, more than a third of oncologists and practice managers said that patients raise cost concerns at their first appointment. These factors may have led to oncologists’ rating patient affordability as the most important non-clinical factor in treatment decisions. While oncologists refer patients who are unable to afford their treatment for financial support, they also alter their treatment choices. In some cases, patients choose to forgo treatment when it becomes unaffordable. A 2011 study in the American Journal of Managed Care2 found that one in four cancer patients who have an OOP cost greater than $500 per month on their initial claim for an oncolytic tend to abandon treatment. However, when OOP costs are less than $100 per month the abandonment rate falls to 6.7%. Manufacturers need to educate practice staff on affordability solutions for their drugs to make sure treatment choices are not being eliminated or abandoned due to financial hurdles.

Financial Assistance Program Design Analysis

Given the critical importance of financial assistance programs, Kantar Health asked practice managers to rate manufacturer programs. Level of financial assistance, easy eligibility requirements and the inclusion of both insured and uninsured patients were identified as the main attributes contributing to a positive financial assistance program experience. Also, drug manufacturers should not underestimate the importance of well-trained, courteous call center staff in ensuring a positive experience.

Not surprisingly, difficult eligibility criteria and inadequate funding are the main attributes contributing to a negative program experience. In light of the shift in coverage between medical benefit and pharmacy benefit, it is important for manufacturers to assess their current program offerings to ensure patients have access to support their needs regardless of benefit design.

Finally, manufacturers will need to monitor payer mix in light of coverage expansion under the ACA with the marketplace plans and the expansion of Medicaid. Commercially insured patients may receive copay assistance directly from the manufacturer, and uninsured patients may be eligible for manufacturer-designed patient assistance programs (PAP). While all patients are eligible for assistance from charitable foundations, foundations represent the only option for Medicare patients who may be “competing” for limited funds. Understanding the breakdown between these patient groups is important, as is understanding the copay levels for those with prescription drug copays or coinsurance. These factors can inform financial assistance strategies, program design and what charitable foundation contributions manufacturers need to make.

Bringing It All Together

Challenges and Manufacturer Considerations:

  • Coverage, and therefore need, will vary across the newly insured; affordability will continue to be a challenge for low-income patients and is growing among the commercially insured.
  • Continued assistance will be required from manufacturers, with more segmentation of support offerings to match segments of patient coverage.
  • Manufacturers will need to provide patient-centered educational materials on coverage and treatment options and costs in support of newly enrolled or eligible patients.
  • Some cancer patients who are eligible for coverage may remain uninsured.
  • It is important to work with oncology groups and patient advocates to provide targeted outreach to ensure enrollment of eligible cancer patients (e.g., those with limited English or less education).

About the Contributor

Katherine DiPaula is an Associate Consultant, Commercial Planning at Kantar Health.

Kantar Health is a leading global healthcare advisory firm and trusted advisor to the world’s largest pharmaceutical, biotech, and medical device and diagnostic companies. It combines evidence-based research capabilities with deep scientific, therapeutic and clinical knowledge, commercial development know-how, and marketing expertise to help clients launch products and differentiate their brands in the marketplace.

Kantar Health’s oncology-related offers include Oncology Market Access US (OMA US), which provides strategic and tactical insights into the evolving oncology landscape. Combining Kantar Health’s commercial and clinical expertise in oncology, OMA US provides cutting-edge information and analysis on critical reimbursement, coverage and competitive issues in the U.S. oncology marketplace.

If you would like us to act as catalysts for you, contact us at www.kantarhealth.com/contactus.

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