Technology Can Help Navigate Financial Assistance Programs in Specialty Care
The goal of the financial counselor is to identify available funding for patient care in a timely manner, but the sheer number of resources and variables involved results in a long, tedious process.
Accessing financial assistance programs (FAPs) is a challenge for even the most skilled financial counselor or navigator. The goal of the financial counselor is to identify available funding for patient care in a timely manner, but the sheer number of resources and variables involved results in a long, tedious process. There’s a lot at stake, from jeopardized outcomes and financial hardship on the part of the patient to the risk of bad debt write-offs for the pharmacy, hospital, or specialty practice.
Fortunately, technological solutions have been developed to help financial counselors navigate and manage these complexities. These systems are capable of using technology, data, and predictive analytics to identify financially at-risk patients and match them with an array of FAP resources—from biopharma manufacturers’ copay assistance or replacement drug programs to foundations and governmental resources that can help with transportation or living expenses. These systems have been developed to proactively prevent financial roadblocks early in a patient’s medical journey before the first drug is dispensed.
When financial roadblocks occur during a patient’s treatment process, they can result in significant setbacks for the patient’s care. A 2018 study found that 32% of cancer patients with between $100 and $500 in out-of-pocket drug costs did not fill their prescriptions, while 50% of patients facing $2000 or more in out-of-pocket costs also left their prescriptions unfilled. Additionally, the investigators noted that about 1 in 8 cancer patients faces more than $2000 in out-of-pocket drug costs.1
An array of trends, such as the rise in high-deductible health plans with steep out-of-pocket costs for patients,2 an increase in high-priced specialty medications,3 and greater financial instability during the pandemic,4 have made the job of the financial counselor more critical than ever. Effective counseling not only helps patients get on treatment and stay the course, but also supports the financial viability of the organizations involved in patient treatment and care.
Having a Plan Matters
For costly therapies that treat conditions such as multiple sclerosis, chronic obstructive pulmonary disease, and cancer, financial counselors can help establish a process for getting as much assistance as possible to patients in need, even before they know they need it.
For example, a 2017 study revealed that access to drug assistance programs increased medication adherence by over 60%.5 However, the key to the success of these assistance programs is early intervention, which allows for the preservation of patient access to care while controlling bad debt write-offs through the improvement of patient collections and funding resources.
Tackling FAP Challenges With Automated Technology
With so many different FAP resources available, each with its own set of qualifying criteria, it can be a time-consuming process to find the right assistance for the right patient. The sheer complexity of the playing field means that health systems or large practices may have multiple financial counselors as full-time employees.
Automated technology can simplify the workflow to help the health care entity bring the focus back to what it does best: providing quality patient care.
Automated technology can help facilitate this process on several levels:
- Identify funding sources quickly
One of the biggest challenges is simply knowing what FAP resources are available for patients and whether they meet eligibility requirements. Automatically leveraging available patient data alongside a vast array of FAP data is an efficient way to match patients with financial assistance programs in real time. For instance, some technological platforms can generate a short list of programs that are currently open for enrollment and for which the patient is eligible so the counselor doesn’t need to sift through hundreds or even thousands of programs to find the right fit.
- Help patients proactively
Technology should use predictive analytics to estimate out-of-pocket expenses on a per-patient basis, enabling a workflow that is proactive rather than reactive. Instead of scrambling to find FAP resources for a patient who is already facing financial hardship, financial counselors can use technology at the start of the care journey to stay ahead of the curve and address patient concerns before they arise.
- Reduce manual workload
Without technology, financial counselors must often resort to a manual search process with tracking sheets, spreadsheets, or folders for each patient. Data ingestion and patient eligibility should be automatic, so the system pulls from existing demographic information to prepopulate FAP applications. This type of software makes it easier to track applications, follow up when needed, and prevent anything from falling through the cracks when securing funds.
- Centralize workflows
Alongside financial counselors, some organizations have social workers or community health workers assisting with each case, helping find travel assistance, gas assistance, and perhaps even social support for patients. Bringing these needs together in 1 platform is important so that all staff involved can quickly discover patient-eligible resources to help with everything from transportation costs to nutrition requirements.
Supportive technology allows for a 360-degree approach to patient care while helping to ensure that patients receive their medication in a timely manner and have necessary resources in place to stay adherent. It also contributes to the financial viability of the health care entity involved in providing that treatment and care to the patient.
With the time and cost savings that such technology affords, financial counselors can help more patients in less time than manual processes allow. Health care entities can reduce their risk of write-offs and bad debt from prescription abandonment, and patients can get a better, more efficient and perhaps even more compassionate experience that alleviates their financial burdens and anxieties, while obtaining their medications when they need them to support their best chance for positive health outcomes.
Brenda Bernard, MSN, RN, OCN, is the director of business advisors for McKesson.
Srulik Dvorsky is the CEO of TailorMed.
- Doshi JA, Penxiang L, Huo H, Pettit AR, Armstrong KA. Association of Patient Out-of-Pocket Costs with Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents. J Clin Oncol. 2018;36(5):476-482. doi: 10.1200/JCO.2017.74.5091
- Cohen R, Zammitti E. High-deductible Health Plan Enrollment Among Adults Aged 18–64 With Employment-based Insurance Coverage. NCHS Data Brief. 2018;(317):1-8. PMID: 30156534
- Purvis L, Schondelmeyer S. Rx Price Watch Report: Trends in Retail Prices of Specialty Prescription Drugs Widely Used by Older Americans, 2006 to 2020. AARP Public Policy Institute. https://www.aarp.org/ppi/info-2019/trends-in-retail-prices-of-drugs.html. Published September 28, 2021. Accessed October 17, 2021.
- US Bureau of Labor Statistics. COVID-19 ends longest employment recovery and expansion in CES history, causing unprecedented job losses in 2020. US BLS website. https://www.bls.gov/opub/mlr/2021/article/covid-19-ends-longest-employment-expansion-in-ces-history.htm. Published June 2021. Accessed October 17, 2021.
- Biggers A, Shi Y, Charlson J, et al. Medicare D Subsidies and Racial Disparities in Persistence and Adherence with Hormonal Therapy. J Clin Oncol. 2016;(36):4398-4404. doi: 10.1200/JCO.2016.67.3350