When Your Insurance Won't Cover Your Cancer Medications

Strategies for Managing the Out-of-Pocket Cost of Your Cancer Treatment

woman holding a bunch of prescription medication bottles
What can you do if your insurance doesn't cover your cancer drugs?. John Moore/Getty Images News/Getty Images

Cancer treatment can be an extremely expensive undertaking. What can you do if your health insurance doesn't cover the cost of your cancer medications?

The Cost of Cancer

From the doctor's visits to the lab to imaging tests to prescription medications, most people cannot afford to pay even a fraction of the total cost out of pocket. And that's not mentioning hospital and surgery bills. Even the best health insurance policies may not cover everything associated with your cancer treatment plan.

Add to that the non-medical costs of transportation, household help, and child care and the bill gets higher.

Of course, at the same time many people are unable to work or at least work as much during cancer treatment. When costs go up and income goes down, there can be a problem. Cancer can put a huge financial strain on families.

Before you get too discouraged, however, there are many options for help. In this article we will deal with medications, but there is help for other cancer costs as well (that we will link to later on.) And if you haven't started to keep track, do so today. There are many tax deductions for people with cancer that may surprise you.

When Insurance Doesn't Cover Your Cancer Treatment

The high cost of cancer care doesn't mean that your only choices are to face financial hardship or to forego treatment. The good news is that there are options available to help people with cancer bridge the financial gap between the cost of their cancer treatment and their insurance coverage, particularly when it comes to the cost of medications.

The following are strategies for easing the financial burden of cancer-related prescription medications your insurance won't cover.

1. Appeal the Insurance Claim Denial

First, you always have the right to appeal your insurance company's denial of services. While the appeal process can be a lengthy and emotionally draining strategy, it is worth a shot.

The process often involves writing letters to the insurance company and gathering information from doctors and other medical professionals. Some cancer patients have found success in appealing the denial of their insurance claims, while others have not.

Since appeals are approved on a case-by-case basis, some cancer patients choose to work with a patient advocate to assist them in the appeals process. Many hospitals and cancer clinics have social workers and patient advocates you can work with. Another great resource is the Patient Advocate Foundation, a non-profit organization that provides professional case management services.

For more information on this strategy, be sure to read our article, How to Fight an Insurance Denial.

2. Apply to Patient Assistance Programs

Most pharmaceutical companies have patient assistance programs that will provide medications like chemotherapy to eligible patients. The eligibility criteria are not always based on income, so don't assume that because you are employed, you are ineligible for the program.

These programs were created for patients without insurance and also for those whose insurance companies do not provide coverage of much-needed prescription medications. The first step is researching which drug companies have patient assistance programs.

Applying to a drug manufacturer's patient assistant program usually requires an application and other paperwork that must be completed by your physician. Your oncologist's office likely is aware of the available programs and may be able to help you fill out the paperwork. Once complete, applications can often be mailed or faxed. Eligibility decisions are usually timely.

3. Ask for Generics or Substitutes

Unfortunately, medication for cancer treatment doesn't stop at chemotherapy. Many times, medications are needed to help manage treatment side effects and other concerns. If the other medication your doctor prescribed is not on your insurance provider's "formulary," ask your doctor if there is an acceptable substitute. You can always request your doctor to prescribe the generic version of the medication if one is available, which generally cuts the cost dramatically.

4. Price Shop Pharmacies

If paying out-of-pocket for non-chemotherapy medications, it is prudent to compare prices at different pharmacies. Not all pharmacies sell medications at the same price. In fact, the difference can be substantial, potentially saving you quite a bit of money. Simply call the pharmacy and tell them what drug you want, the dosage and quantity, and ask for the cost. It is common for customers to check pharmacy prices, so don't feel uncomfortable doing so.

When price shopping, you may be tempted to use online pharmacies that boast unbelievable prices for prescription drugs. Most of the time, if it sounds too good to be true, then it probably is. Many online pharmacies, especially those based in other countries, sell "bootleg" versions of drugs. The drugs may not come from the brand manufacturer and can contain unidentified ingredients that may harm you.

Coping with Finances During Cancer Treatment

As we promised earlier, there is help available for costs beyond prescription medications. As with your cancer medications, this can take a little leg work, and this may be a good time to accept help from someone who has been asking what they can do to assist you.

This article on financial help for cancer patients lists organizations that provide help and other ideas for increasing funds, as well as when you may want to apply for disability.

If you're still feeling at a loss, brainstorm your connections. Does your church have a benevolence fund? Do you know anyone willing to lend you the money? One way of gathering funds that has helped many is to have a cancer fundraiser. Do you know someone in your life who enjoys throwing a party? Many retail companies are willing to donate for silent auctions, and it's likely many of your friends would find it easy to donate a few dollars for a nice evening out to dinner. That can add up. Check out these tips on planning a fundraiser for someone with cancer. Another option that has worked for many has been using a social media donation site. You may be surprised at the number of people—many who you may not even know—who are willing to help out for a good cause—a cause like your emotional well-being as you go through the physical battle of cancer you must face alone.

The Bottom Line: Don't Give Up

The challenge of financing your cancer treatment or simply closing the gap between your insurance coverage and the actual cost of treatment can be exhausting. Between the complicated appeals process, assistance program applications, and endless phone calls, some days it may not feel like it's worth it to keep fighting, but it is. There are many success stories out there, and you can be one of them. Keep up the fight.

Sources:

Gao, L., Joseph, J., Santoro-Levy, M., Multz, A., and V. Gotlieb. Utilization of Pharmaceutical Patient and Prescription Assistance Programs via a Pharmacy Department Patient Assistance Program for Indigent Cancer Patients. Hospital Pharmacy. 2016. 51(7):572-6.

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