How to Effectively Decrease Patient Co-Payments of High-Cost Drugs Through Innovation: Lessons From the Karmanos...

Area of Science:

• Oncology Pharmacy Practice
• Health Services Research
• Health Economics

Background:

• High-cost cancer drugs present significant financial challenges for patients.
• Specialty pharmacies play a crucial role in managing medication access and affordability.
• Automating financial assistance processes can alleviate patient financial burdens.

Purpose of the Study:

• To evaluate the impact of an automated financial assistance (FA) application process developed by Karmanos Specialty Pharmacy (KSP).
• To assess the reduction in patient and payer costs associated with high-cost cancer drugs.
• To analyze the types and sources of financial assistance obtained.

Main Methods:

• Observational, retrospective study utilizing KSP claims data from January to December 2019.
• Analysis of drug costs, financial assistance (FA) amounts, and types of FA across different insurance payers (Medicare, private, Medicaid).
• Subset analysis to determine prescription drug delivery times.

Main Results:

• Approximately $10 million in drug claims for Medicare patients, $3.4 million for privately insured, and $3.7 million for Medicaid patients.
• 27% of patients required additional FA, with obtained assistance reducing total patient costs by 81%.
• Foundation grants were the primary source of FA, particularly for Medicare patients, with a median prescription delivery time of under 7 days.

Conclusions:

• An automated FA application process significantly reduced patient out-of-pocket costs for high-cost cancer drugs.
• The KSP process, enhanced by additional pharmacy assistants, proved effective in securing financial aid.
• Efficient FA processes are vital for improving access to and affordability of cancer medications.