How to Pay for Chemo Without Health Insurance

A 2003 study by Project HOPE examined cancer patient data from the Medical Expenditure Panel Survey (MEPS) and found that approximately ten percent (10%) of cancer patients under 65 years of age (and, therefore, not covered by Medicare) are without health insurance. Among Hispanic cancer patients, the percentage of uninsured is as high as 20%, and likely accounts for the disparity in cancer treatment, and even survival rates, when compared to same-age white cancer patients.

Lack of insurance need not relegate patients to substandard health care. Unfortunately, cancer patients may not be aware that help is available to pay for chemotherapy if they find themselves without health insurance. Sources of financial resources include, but are not limited to, manufacturer patient assistance programs and patient advocacy organizations. These funding sources tend to be the easiest to navigate and most dedicated to ensuring that the patient continues to receive medication for as long as it is needed.

Instructions

Manufacturer Assistance Programs

• 1

  Identify the manufacturer of the chemotherapy or other cancer treatment product your physician recommends or prescribes for your condition.

  Example: Patient is diagnosed with non-small cell lung cancer, and physician wants to treat with Erbitux. If an internet search is performed, specifying "erbitux manufacturer," the result will show that Bristol-Myers Squibb is the manufacturer of the product. An oncologist will likely know the manufacturer of prescribed medications, and can be a good resource.

• 2

  The "magic words" for finding help in paying for chemotherapy from manufacturers are "patient access" or "patient assistance" or even "PAP," combined with the name of the particular drug.

  Using the example of a patient prescribed Erbitux to perform an internet search for Erbitux assistance programs reveals that Bristol-Myers Squibb has a program called "Destination Access."

• 3

  Follow the link to the manufacturer website for any access program.

  The Bristol-Myers Squibb Destination Access program for Erbitux is fairly representative of the type of help manufacturers are willing and able to give. A patient with an adjusted gross income of $75,000 or less qualifies for free Erbitux prescribed for a medically accepted reason, and can also get a refund for the cost of Erbitux not covered by insurance within sixty (60) days of enrolling in the program.

  Patients that are insured can also enroll in the program if their insurance company will not cover the medication.

• 4

  Call the toll-free number provided on the applicable program's website for enrollment information and provide all information requested in a timely manner.

  It may be possible to download an enrollment form that can be sent by fax to the manufacturer.

• 5

  Follow up on the status of the enrollment application. If accepted into the program, inquire about medication refill procedures to ensure that all medications are received when needed.

  If the application is denied, the manufacturer may be aware of other programs for which the patient is eligible.

Patient Advocacy Organizations

• 6

  Many cancers are classified as "rare disorders." The National Organization for Rare Disorders' (NORD's) website at http://www.rarediseases.org/search/rdblist.html lists the diseases for which it provides information, advocacy, and assistance.

  Patients falling outside eligibility for a manufacturer patient assistance program may be eligible under NORD's standards.

• 7

  Go to NORD's database of assistance programs page at http://www.rarediseases.org/search/orgsearch.html and type in the cancer type.

  Follow the links to the resources listed.

• 8

  NeedyMeds is a database of assistance programs for cancer and other chronic or life-threatening illnesses.

  Patients can find programs that help pay for chemotherapy by searching the brand name or generic name of the needed medication, or by searching by disease. The treating physician is the best source for the exact language to use in a search to ensure adequate and complete information.