The Growing Need for Co-Pay Assistance The National Congress for the Un and Under Insured

The Growing Need for Co-Pay Assistance

The National Congress for the Un and Under Insured

September 2008

For more information contact: Julie Reynes, [email protected]

Agenda

• The Under-Insurance Problem

• A Changing Healthcare Environment

• Impact of Changes on Co-Pay Assistance Needs

mailto:[email protected]


How Big is the Problem?

• The Commonwealth Fund, estimates that 25 million people in the US, under 65, are underinsured

• Being “underinsured” is defined as having out-of-pocket healthcare costs exceeding 10% of their income (or 5% for lower income adults)

• This is a 60% increase in the number of underinsured from 2003 to 2007

• Quite often individuals must make difficult decisions between paying for rent and daily necessities or paying for life-saving medications

These numbers do NOT include the millions of Americans over 65 who are under-insured, have Medicare , but no supplemental insurance, or have no

insurance at all.



Healthcare Costs Are Increasing

Source: 2008 Milliman Medical Index



The Impact of Being Underinsured

Source: Commonwealth Fund Biennial Health Insurance Survey



Why Co-Payment Assistance?

Pharmacy cost trends upward exceeded all other components of medical care from 2007 - 2008.




Why Co-Payment Assistance?

• Prescription drugs have the largest co-payments

• Prescription drug costs are estimated to continue increasing in the near term

• Physicians and hospitals have the flexibility to reduce or waive their fees for lower income patients

• If a patient can obtain the thousands of dollars it may cost to access their medications, they will be more likely to get treatment

‘We found that reductions in drug copayments increased medical adherence.’ Michael E. Chernew, Health Affairs, Jan-Feb 2008




Changing Healthcare Environment

• Physicians are increasingly requiring co-payments for drugs before treatment is provided

• Employees are struggling to handle double digit increases in insurance premiums

• Medicare payments continue to get squeezed

• Insurers are increasing co-payments associated with expensive drugs. This currently impacts:

• 86% of Medicare Part D drug plans• 10% of private drug plans

• Changes from a new administration may increase the number of under-insured

Source: Co-payments for Expensive Drugs Soar, The New York Times, April 14, 2008 and 2008 Milliman Medical Index

Bottom Line: The need is increasing.



Patient Access Network

Dedicated to improving access to needed health services for insured patients who cannot afford the out-of-pocket costs

associated with their treatment.

• A public charity that launched our initial assistance program in October, 2004.

• Currently supports 20 disease-state funds for oncology and chronic diseases.

• Provides co-pay assistance of from $1500 - $7500 per year for medications.

• Received favorable advisory opinion from the Office of the Inspector General (OIG) of the Department of Health and Human Services in December 2007.

• Have approved nearly 50,000 patients for cost-sharing assistance.



Patient Access Network Supports the Under-Insured

Co-payment assistance is not just for the indigent. It is for patients who might not get life-saving treatments because

of the expense.

Co-payment assistance is not just for the indigent. It is for patients who might not get life-saving treatments because

of the expense.

1-2 FPL 22,481

61%

2-3 FPL 11,22130%

3-4 FPL3,387

9%

2 times the Federal Poverty Level for a Household of 4 is $42,400 per year.

2 times the Federal Poverty Level for a Household of 4 is $42,400 per year.

Source: Patient Access Network Data, 2004 - 2007

Approvals by Income Level


The Need for Co-pay Assistance from PAN is Increasing

Demand is increasing by over

30% each year, while revenues remain stable

Source: Patient Access Network Data, 2004 - 2007

Projected2008


A Patient Perspective

“I sat in the oncologist’s office and kept saying, I

don’t have the money , but I’m not going to die

because I can’t pay for this. I am not going to die

because I am underinsured.”

Judy Hodges, PAN Patient


Conclusions

• Insured populations are having difficulty accessing needed healthcare

• Co-payment assistance is an important mechanism for getting help where it is needed

• We believe that co-pay assistance organizations currently meet only 10% – 15% of the need (based on internal PAN claims-based models)

PAN is experiencing unprecedented demand. Without additional support we will be unable to meet this demand.

PAN is experiencing unprecedented demand. Without additional support we will be unable to meet this demand.

The Growing Need for Co-Pay Assistance The National Congress for the Un and Under Insured

Documents

Transcript of The Growing Need for Co-Pay Assistance The National Congress for the Un and Under Insured