Prostate Cancer Lab #35: Paying for Cancer Treatments

Advanced cancer patients are fighting to survive, and at the same time many feel they have to choose between putting food on the table for their families or paying for their care. Some hold up treatment while they sort out finances. Others get excited about a new drug, but don’t pursue it because it’s too expensive. Many advanced cancer patients and caregivers need help to minimize the financial burden and stress of paying for testing and treatment, including “financial toxicity” (fees beyond ability to pay), shopping for drugs, dealing with insurance, and negotiating with providers.

Advanced cancer patients Kevin Fordney, Rick Stanton, and Mike Yancey, and Nancy Novack, Founder and Executive Director of Nancy’s List, shared their experiences in navigating paying for cancer treatments and hacks they have discovered.

What are the biggest problems advanced cancer patients face in paying for cancer care?

The recurring problem we heard from the advanced cancer patients in our community is navigating the very wide range of prices for the drugs they need. For example, a common hormone treatment for prostate cancer, abiraterone, can cost from $10 to $2,500 per month depending on the pharmacy the patient chooses.

Case Examples: The Quest for a Lower Price for Abiraterone

Consider the case of Mike Yancey, an advanced prostate cancer patient who was prescribed abiraterone (Zytiga), a drug that blocks hormones from feeding his prostate cancer. His original cost was $2,300 a month. He reached out to the manufacturer for financial assistance, but they weren’t much help. Then through his Medicare Part D plan, he got a revision down to about $1,100 a month. Not satisfied, he got his insurance provider Humana to bring his price down to about $500 a month. Still dissatisfied, he did some online searching and found a company called QuickRx which offered a lower price. Because Mike was concerned that there are a lot of fly-by-night online pharmacies out there, he checked the FDA site, and confirmed that QuickRx was indeed a valid, FDA-approved pharmacy. QuickRx quoted him $240 a month for one year, and they guaranteed it for one year. They claimed they had benefactors that wanted people to have their drugs, so they were able to offer cheaper drug prices. He accepted their offer. Within the last two months, it’s dropped from $240 to $180 a month. For 2023, he is looking at the Walgreens Part D plan. It will make his abiraterone a little bit cheaper going forward.

Also consider the case of Kevin Fordney, another advanced prostate cancer patient. He was quoted $2,400 a month for abiraterone (Zytiga), and was told about “doughnut holes”, and that he shouldn’t worry because it wasn’t going to cost him $30,000 a year. He filled out an elaborate application to the drug company. Not satisfied, he called CVS Pharmacy because they were the pharmacy connected with his insurance, and he was quoted $2,500 a month and heard the same doughnut hole story. Then by chance he got a GoodRx card in the mail. He had thrown away other ones for years. He went online, entered the drug and his zip code, and it brought up all the pharmacies and prices for abiraterone in his area. Walmart, which usually has an everyday low price, was listed at over $5,000. Costco was the lowest, so he chose them and paid $180 the first month. Then he got a call from a patient advocate at OHSU, and they put him on the phone with The Assistance Fund. He didn’t expect he would qualify, as he projected how they determine the poverty level. But they said, “Oh no, that’s not how this works.” He was accepted by The Assistance Fund. He showed Costco the patient letter from The Assistance Fund, and he now pays $10 a month!

What are some tips for navigating around the challenges of paying for cancer testing and treatment?

• Shop: Go on the web and find out what the best deals are for your services, including drugs and the best insurance company for you. Use GoodRx or QuickRx. Use The Assistance Fund. Also, as your drug needs change, the plan you’re on may no longer provide the least expensive options. Mike Yancey found a plan that offered a lower cost for the drugs he was currently taking, but he also wanted to plan for the future, which included other drugs. He chose the lowest cost plan based upon everything, even though he might be paying a little bit more for his current drugs in the beginning.
• Contact the manufacturer: Pharmaceutical companies have medication assistance programs which offer reduced prices for patients who ask. NeedyMeds can help you through the process.
• Get help: Get someone to take care of bill paying for you, so you can reduce your stress and focus on taking care of yourself. The Patient Advocate Foundation provides case managers who “advocate and mediate on behalf of patients to provide avenues of access for therapies, therapeutic agents, and devices deemed medically efficacious by the medical and scientific communities while working to find sources of reimbursement to pay for care.”