Transcript Average Monthly Out-of-Pocket Costs

Support for the Financial and Other Costs of Cancer Care
Trish Goldsmith
CancerCare © 2016 Patient Access and
Engagement Report - Confidential – Not For
Distribution.
Among respondents younger than 65, 10% to 25% reported being dissatisfied with certain
aspects of their insurance coverage for cancer treatment. Those areas that garnered the most
dissatisfaction include access to new treatments or genetic testing, ability to pay for medications,
affordability of co-payments and deductibles, co-pays for tests, access to complementary
therapies, and access to an insurance case manager.
Dissatisfied with aspects of Insurance Coverage for Cancer
Ages 25 to 64 (n=341)
The choice of doctors
The choice of hospitals and/or treatment centers
Getting timely approvals for tests or procedures
Access to advanced imaging technology
Access to newly approved treatments or drugs
In-network access to psychological counseling/support
Access to genetic testing
Access to Clinical trials
My ability to pay for medications recommended by my doctor
Affordability of co-payments
Access to an insurance case manager who explains/assists with…
Amount I have to pay for the tests recommended by my doctor
Access to complementary therapies such as acupuncture or massage
Affordability of deductibles
0%
5%
10%
15%
Q. 14: How satisfied are you with the following aspects of your insurance coverage for your cancer treatment?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
20%
25%
30%
Referrals for financial support were even lower than those for emotional support. Similarly,
however, PCPs referred more often than other care team members, and referrals were rarely made
for respondents 55 years and older.
Care Team Members Making Support Referrals - Financial
% of respondents
40%
Per survey 6, incidence of distress regarding
finances for 25-54 year olds is 69%; for 55 and
older, it’s 33%.
22% *
*
19%
20%
13%
*
9%
5%
11%
9% *
7% *
5%
2%
4%
2%
0%
PCP
Oncologist
Family Member/
Caregiver
25 to 54 Years Old (n=189)
PA or NP
Social Worker or
Psychologist
Nurse
55 and Older (n=312)
*Indicates statistically greater at 90% confidence level
28. Which of the following members of your cancer care team have referred you to a patient support service or professional to help you cope
with financial distress?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
n=501
Of those respondents ages 25 to 64 years old, 25% stopped working during treatment and 13%
switched from full- time to part-time employment. Approximately one-third of all respondents
continued to work full-time.
Employment Status During Treatment
60%
% of respondents
47%
40%
34%
*
35%
25%
*
20%
14%
13%
8%
13%
10%
*
1%
0%
Continued working
full time
Stopped working
N/A,
Not working before
receiving treatment
25 to 64 Years Old (n=341)
Continued working
part time
Switched from full time to
part time work
65 and Older (n=168)
10. What was your employment status while you were being treated for cancer?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
n=509
Roughly one-fifth to one-third of patients reported it was difficult to determine out-of-pocket costs
before incurring the expense. This finding did not vary based on patients’ demographics or the
length of time since diagnosis. Out-of-pocket hospital fees were considered the most difficult to
determine.
Ease of Determining Out-of-Pocket Costs
100%
% of respondents
80%
21%
25%
26%
28%
24%
25%
24%
41%
37%
35%
35%
32%
Physician Fees
Scans and X-rays
Treatments
Procedures
Hospital fees
31%
60%
25%
23%
40%
20%
0%
n=509
Somewhat or Very Easy
Neither Easy or Difficult
Somewhat or Very Difficult
44. How difficult or easy was it for you to determine the out-of-pocket cost of each of the following BEFORE you incurred the expense?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
Average monthly out-of-pocket costs for patients in treatment, ages 25 to 64, are $1112,
compared to $584 for those 65 or older. About a quarter of the monthly expense is for copays and deductibles for drugs, doctor visits and tests. Another third reflects spending on
services and non-prescription medicines to help with symptoms and side effects.
Average Monthly Out-of-Pocket Costs
$350
Average Cost
$300
B
$299
$200
B
$208
B
$212
$250
B
$205
B
$188
$165
$127
$150
$97
$100
$97
$98
Special clothing,
wigs, etc.
Non-prescription
medications
$50
$0
Co-payments and
deductibles for drugs,
doctor visits and tests
Transportation to and
from clinic visits,
baby-sitting,
Services to help with
symptoms and side effects
such as acupuncture or
massage therapy
25 to 64 Years Old (n=341) (A)
65 and Older (n=168) (B)
* Letters indicate statistically greater at 90% confidence level
45. Thinking about the time you were getting cancer treatment, on average, how much did you spend out of pocket each month on the following?
CancerCare 2016 Patient Access and Engagement Report © - Confidential - Not for Distribution
Among respondents under Medicare age, 25% reported that their financial situation was never
considered by their care team in treatment planning and 34% say it was sometimes considered. Yet,
58% reported being distressed about their finances while in treatment.
Frequency Health Team Considers Patient’s Financial Status when Planning Treatment
% of respondents
100%
80%
60%
40%
25%
36% *
34%
41%
29%
35%
20%
0%
Never or Rarely
Sometimes
Often or Always
% of respondents
Patient’s Level of Financial Distress During Treatment
100%
*
76%
80%
60%
40%
20%
30% *
28%
7%
42%
*
17%
0%
Extremely/Very Distressed
Somewhat Distressed
25 to 64 Years Old (n=341)
Not At All/A Little Distressed
65 and Older (n=168)
*Indicates statistically greater at 90% confidence level
31. How often do you feel your healthcare team takes your financial situation into consideration when recommending treatment options?
23. Thinking about the time when you were getting cancer treatment, how distressed (e.g. anxious, extremely upset, or in emotional pain) were you from
thinking about your finances?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
Expenses related to cancer treatment had an impact on numerous aspects of patients’ finances. Onethird of respondents ages 25 to 54 cut back on essentials such as groceries and transportation and/or
borrowed from family/friends; one-quarter applied for assistance from patient organizations or
providers; 21% missed utility bills; and 17% missed rent/mortgage payments.
Experiences Due to Treatment Bills
I asked for financial help
from a church or…
36%
41%
I cut back on non-essential
expenses
I cut back on groceries,
transportation, clothing,
tuition
20%
11%
I borrowed money from
family/friends
I applied for financial
assistance from a patient
support organization
I applied for financial
assistance from my doctor’s
office or hospital
6%
4%
I missed paying bills such as
heat, electricity, phone
0%
4%
I considered declaring
bankruptcy
24%*
I moved to a less
expensive home
24% *
I borrowed money from a
bank or credit union
40%
60%
11% *
2%
11%*
6%
2%
0%
*
11%
5% *
5%
10%
15%
% of respondents
% of respondents
25 to 54 Years Old (n=215)
*
17% *
4%
I declared bankruptcy
21% *
20%
17%
I missed rent/mortgage
payments
33%*
31% *
9%
3%
55 and Older (n=294)
*Indicates statistically greater at 90% confidence level
33. Which of the following have you experienced as a result of bills related to your cancer treatment? Please select all that apply.
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
20%
Many patients, especially those ages 25 to 54 years, took steps to reduce the costs of treatment,
some of which may have compromised their cancer treatment: 39% skipped doctors’
appointments; 38% postponed or did not fill prescriptions; 34% skipped doses of prescribed
drugs; 30% ordered medication from non-US sources; and 31% cut pills in half.
Steps Taken to Reduce Treatment Expenses
Done Often or Always
Done Sometimes
25 to 54
Years Old
(n=215)
55 and
Older
(n=294)
25 to 54
Years Old
(n=215)
55 and
Older
(n=294)
27%
10%
17%
4%
27%
7%
16%
8%
27%
7%
16%
5%
25%
6%
18%
5%
Postpone or skip psychological counseling or support
24%
6%
16%
4%
Apply for financial assistance from my doctor/hospital
24%
4%
21%
7%
Discuss changing my treatment to one that costs less
24%
3%
19%
10%
Postpone or skip follow-up testing
23%
4%
16%
5%
Postpone or not fill prescriptions
21%
2%
17%
6%
Postpone or skip doctor's appointments
20%
2%
19%
7%
Skip dosages of prescribed drugs
20%
2%
14%
5%
Postpone or skip blood work
17%
2%
18%
3%
Order medications on-line from non-US sources
Cut pills in half
16%
14%
3%
4%
14%
17%
2%
4%
Apply for co-pay assistance to cover medication costs
Choose to use a lower cost medication than what the doctor
recommended
Delay or skip complementary treatment
Apply for financial assistance for non-medical expenses such as
transportation
Indicates statistically different at 90% confidence level
25. How often do you do each of the following in order to REDUCE your expenses related to your cancer treatment?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
Among those ages 25 to 44, 39% of respondents indicated that their insurance company
required they follow a step-therapy process to manage symptoms/side effects. For a majority of
these patients, this required using a non-preferred medicine for 2 to 3 months.
Step Therapy: Required Time
for Using Mandated Medicine
Insurance Company Required
Step Therapy
60
100%
56%
88%
80%
40
55%
60%
40%
21%
39%
21%
20
20%
7%
6% 5%
0
0%
Yes
25 to 44 (n=145)
No
Don't know
45 and older (n=382)
One month or
less
Two to three
months
Four to six
months
25 to 44 (n=145)
23. Has your insurance company ever required you to follow ''step therapy'' to manage any symptoms/side effects you experienced?
24. How long did you have to use the first medicine before you could have the one you and/or your doctor preferred to manage your
symptoms/side effects?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
As a result of having cancer, the ability to perform day-to-day activities was dramatically compromised
for one-quarter to one-third of respondents. Even some of those whose treatment was completed,
whether or not they were on maintenance therapy, continued to suffer in this way.
Activities Reduced Completely or A Lot
50%
40%
46%
37%
37%
34%
37%
34%
36%
30%
20%
10%
34%
26%
19%
17%
33%
25%
28%
26%
24%
28%
24%
17%
9%
12%
22%
19%
19%
14%
13%
7%
4%
7%
13% 13%
6%
3%
0%
In Active Treatment (n=102)
Completed Treatment, On Maintenance Therapy (n=118)
Completed Treatment, Not On Maintenance Therapy (n=257)
43. How much has your ability to do the following activities been reduced as a result of having cancer?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
Having cancer changes lives, especially for those ages 25 to 54. About one-half of the respondents
in this age bracket reported a lot or complete change in the physical, emotional, financial, social,
and spiritual aspects of their lives. Another one-quarter reported moderate changes in these
areas.
Changes in Life Since Cancer Diagnosis
Physical
Emotional
Social
Financial
Spiritual
100%
% of respondents
19%
80%
*
38%
25%
*
20%
*
44%
24%
60%
40%
24%
30%
*
56%
24%
29%
*
31%
*
61%
58%
30%
25%
*
57%
26%
*
32%
*
52%
32%
*
47%
24%
21%
*
19%
46%
*
43%
23%
19%
24%
19%
0%
25-54
Years Old
(n=267)
55 and
Older
(n=238)
25-54
Years Old
(n=267)
55 and
Older
(n=238)
A Lot or Complete Change
25-54
Years Old
(n=267)
55 and
Older
(n=238)
Moderate Change
25-54
Years Old
(n=267)
55 and
Older
(n=238)
25-54
Years Old
(n=267)
Slight or No Change
*Indicates statistically greater at 90% confidence level
10. Compared to before you were first diagnosed with cancer, how much change has there been in the following aspects of your life?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
55 and
Older
(n=238)
For the vast majority of respondents, being diagnosed with cancer caused distress. The impact of
cancer on their family was most often reported as being extremely stressful. In all aspects of life
mentioned in this survey, respondents ages 25 to 54 were significantly more likely than those 55
and older to report being highly or extremely distressed.
Cancer-Related Distress
25-54 Years Old (n=267)
The impact of your cancer on your
family
48% *
28%
30% *
How you feel physically
42% *
Finances
40%*
29%*
*
28% *
Ability to work
39%
Ability to do things you love to do
*
38%
24%
How long you expect to live
35% *
*
30%
0%
20%
55 and Older (n=238)
40%
20%
24%
13%
29%
19%
31%
38%
60%
14%
35%
80%
Somewhat Distressed
66%*
14%
74%*
14%
100%
0%
66% *
20%
71% *
15%
20%
% of respondents
Highly or Extremely Distressed
67%*
20%
16% 10%
33%
52%*
28%
40%
60%
% of respondents
Not At All or Slightly Distressed
*Indicates statistically greater at 90% confidence level
11. How distressed (anxious, extremely upset, or in emotional pain, for example) have you been due to the impact cancer has had on
the following aspects of your life?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
80%
100%
Respondents ages 25 to 54 experienced similar levels of distress due to the impact of cancer,
regardless of ethnicity. African Americans/Hispanics, however, were significantly more likely than
whites to report being distressed about how long they expected to live.
Cancer-Related Distress – Ages 25 to 54
White (n=120)
The impact of your cancer on your family
51%
Ability to work
41%
Finances
40%
Ability to do things you love to do
38%
How you feel physically
38%
How long you expect to live
36%
0%
20%
African American / Hispanic (n=133)
23%
23%
37%
28%
33%
28%
30%
60%
30%
38%
31%
31%
100%
0%
20%
% of respondents
Highly or Extremely Distressed
Somewhat Distressed
21%
44%
28%
36% *
35%
80%
22%
33%*
44%
43%*
21%
32%
37%
35%
34%
33%
40%
46%
26%
40%
60%
29%
29%
80%
% of respondents
Not At All or Slightly Distressed
*Indicates statistically greater at 90% confidence level
11. How distressed (anxious, extremely upset, or in emotional pain, for example) have you been due to the impact cancer has had on the following aspects of
your life?
CancerCare © 2016 Patient Access and Engagement Report - Confidential – Not For Distribution.
100%