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High Out-of-Pocket Costs Cause Cancer Patients to Cut Care

High out-of-pocket medical costs prompt cancer patients—even those with health insurance and prescription coverage—to scale back on medications, doctor appointments and basic necessities such as food, according to a study released at June’s annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago.

To better quantify the urgent need for co-payment assistance and to call further attention to the plight of the underinsured in America, the HealthWell Foundation® sponsored the research study by Dr. Yousuf Zafar at Duke University Medical Center. The study assessed the impact of out-of-pocket medical costs on cancer patients’ ability to follow their treatment protocols.

“Health reform has not designed anything to address underinsurance,” said David Knowlton, a HealthWell board member and president of the New Jersey Health Care Quality Institute. “This study quantifies the breadth and impact of this nationwide dilemma,” he said.

“As Congress and the states improve existing insurance plans and work to create new ones, we call on them to ensure adequate coverage that protects against tremendous out-of-pocket burdens on insured individuals,” Knowlton said. “Until that change is effected, the HealthWell Foundation remains dedicated to reducing the financial burden on patients so they can access urgently needed medications.”                                                   

For the Duke study participants, out-of-pocket expenses averaged $712 a month for doctor-visit co-pays, prescription medicines, lost wages, travel to appointments and other expenses. This resulted in either a moderate, significant or catastrophic burden being reported by 80% of study participants.

“With unemployment persisting and employers cutting benefits, patients are now shouldering a higher percentage of their prescription drug costs,” said Jeffrey Peppercorn, M.D., MPH, associate professor of medicine at Duke, a study co-author and chief ethics advisor for the HealthWell Foundation. “But there’s little data available quantifying the financial impact on patients and how medical costs affect their treatment decisions. This study shows that patient costs are substantial and those costs are influencing therapeutic choices for patients with cancer.”

Since its inception in 2004, the HealthWell Foundation has provided co-payment assistance to more than 100,000 patients, including Beverly Chapman of Omaha, Nebraska. “After paying for eight years of medication for breast cancer and rheumatoid arthritis, our funds were almost depleted,” Chapman said. “My doctor prescribed a new medication that cost $1,500 a month, which was more than we could afford, even with Medicaid. When I didn’t take it, I could barely move and was in significant pain. I received a grant from HealthWell and am now more active again.”

According to a May 27 article in USA Today, two recent studies measured the impact of missed prescriptions in terms of resulting emergency room visits, doctor visits and hospitalizations. A study by Express Scripts, an independent prescription-filling company, measured the financial impact of this additional care at as much as $258 billion a year. A study conducted by CVS Caremark, Harvard University and Brigham and Women’s Hospital cited $290 billion in waste.

About the HealthWell Foundation®

Since 2004, the HealthWell Foundation® has helped more than 100,000 insured patients with chronic and life-limiting illnesses meet their cost-sharing obligations for treatment. HealthWell is an independent 501(c)(3) nonprofit association that provides financial assistance to cover the cost of prescription drug co-insurance, co-payments and deductibles, health insurance premiums, and other selected out-of-pocket healthcare costs. For more information, visit

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