Use of a Prescription-Assistance Program for Medically Uninsured Patients With Cancer: Case Study of a Public...

With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading class in hospital drug expenditures. Cancer treatments are causing a serious financial burden for patients, families, hospitals, and society at large, especially for those who are uninsured. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at Nassau University Medical Center (NUMC) with drug costs for chemotherapies, a clinical pharmacist-managed PAP was implemented to procure chemotherapy medications from pharmaceutical manufacturers. NUMC is a safety-net teaching hospital in suburban New York. It serves mostly an indigent population, and its Level I trauma center has more than 77,000 emergency department visits per year.

We observed all patients requiring assistance with chemotherapy who enrolled in PAPs from January 1, 2011, through December 31, 2012. The total number of visits in the clinic over 24 months was 9,405. Individuals potentially eligible for the PAP were identified by oncologists. Patients received a referral to the PAP when they mentioned to office personnel that they had difficulty obtaining medications or expressed financial concerns related to management.

The clinical pharmacist spent the majority of his time assisting uninsured individuals, working with charity pools from the drug manufacturers, and obtaining medications through the PAP. The program served 341 patients in 2011 and 579 patients in 2012. Medications obtained for these patients included both oral and parenteral chemotherapy drugs and antiemetics. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. In 2012, a total of 783 prescriptions were processed, and 775 were approved by the manufacturers (98.9%).

PAPs provide a valuable safety net to ensure that uninsured patients with cancer receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. For the pharmacy department, this has resulted in a lack of compensation for pharmaceuticals dispensed to indigent patients. A pharmacy-based program to procure free medications for uninsured patients with cancer has helped to defray the expenses of the Cancer Care Center in providing care at NUMC, increased patient compliance with chemotherapy protocols, and allowed many patients to receive the treatments they otherwise would not have been able to afford.