Addressing the Costs of CML Treatment
- Tyrosine Kinase Inhibitors (TKIs) are the most effective treatment to control CML.
- Patients usually take the TKI therapy indefinitely to control the disease, so the cost can be an important consideration.
- These medications can be expensive and insurance co-pays can vary a great deal.
- Social support and patient navigator programs can help patients by referring them to financial assistance in a timely fashion.
- It’s important to know how your insurance policy works and whether your insurance will cover the cost of the CML treatment.
Other than the medication itself, the cost also includes necessary follow-up, regular blood work, management of side effects from the treatments, and future need for chemotherapy or bone marrow transplants.
Read MoreWill Insurance Cover My CML Treatment?
A lot of patients ask their doctor, "Will the insurance cover the cost of my CML drug?" Doctors say the answer is "maybe." This is because your TKI may not be covered fully by your insurance plan. "Oral oncolytics [the destruction of tumor cells] are sometimes not really covered by insurance. We bring some specific patients if they don’t have good insurance or insurance with a high level of co-payments, right? And that’s exactly where the financial toxicity issues coming from," Dr. Javier Pinilla, a hematologist/oncologist at Moffitt Cancer Center, tells SurvivorNet."Can you imagine covering 80% of a drug that costs a hundred thousand per year? So that’s the reason that companies and, Leukemia & Lymphoma Society, and other societies such as CML society try to help patients to overcome these financial problems,” Dr. Pinilla adds.
Even though the high cost of TKI may put you under a lot of financial strain, the good news is that there are several government programs, hospital grants, and cancer charities available to offer help and support.
What is Financial Toxicity?
Financial toxicity is a relatively new term that describes the difficult financial impact on cancer treatment. Cancer treatments can be quite expensive and even for insured patients, there may be a huge out-of-pocket cost. Patients sometimes make difficult choices to alleviate the financial burden.
In some instances, the patients cannot afford their medications, so they might cut their pills in half or not refill their medications for several weeks. This can have a negative effect on the treatment outcome to maintain your remission or cancer-free period. There is no overnight fix for this problem, but well-targeted financial assistance could produce better outcomes and improve quality of life. Your cancer center can help address any concerns you might have about the cost of your cancer drugs.
Understanding the Cost Associated with CML
Soon after your diagnosis, your doctor may prescribe you to one of the TKIs. The costs of these medications can vary greatly depending on the type of insurance plan you have. In addition, some insurance companies will cover only one type of TKI. The out-of-pocket cost typically includes doctor visits, blood work, and copay/coinsurance for the TKI. If you have Medicare, some of its plans may cover the cost of TKI, while others may not. Medicaid coverage varies depending on the location you live in.
Health insurance may cover the following aspects of cancer treatment:
- Clinic visits for follow-ups with oncologists
- Blood work
- Imaging studies
- Procedures and treatments such as bone marrow biopsy
Also, if you become sick from the side effects of the TKI or require hospitalization, additional expenses such as food, lodging, travel, and childcare may also need to be taken into consideration.
How Do I Pay for CML Treatment?
Most health insurance companies will cover CML medication and treatment costs, but your policy may not always cover everything. Alternatively, you may not have health insurance. When you have a fixed income and facing an unexpected cost, your financial navigator or patient care advocate at the cancer center can help you navigate this difficult time. Also, talk to your insurance provider to get an estimate of out-of-pocket expenses as well. Here are some options you may find helpful:
- Ask your hematologist for a financial counselor, social worker, and/or nurse navigator who can create a plan that works for you.
- Look into your coverage to determine how much copays and other out-of-pocket costs may be beforehand.
- Discuss generic drug options, which can be just as effective, with your doctor.
- Discuss the need to get prior authorization request with your doctor to determine whether the drug is covered.
- If your claim is denied, your doctor may also need to file an appeal with the insurance company. This can happen if you are prescribed a newer generation of TKI and can take weeks to months to handle.
- You may be eligible for Medicare Part D or Medicaid even if you have health insurance.
How Can I Get Financial Assistance for TKI?
Talk to your doctor and financial navigator about your treatment options and look into assistance programs and charitable organizations to help you cover the treatment costs. Here are some resources and support groups that may help:
- A compassionate care program may be a good alternative. As long as you are receiving continued clinical benefits from the drug, these programs can sometimes pay the entire cost of treatment.
- Many pharmaceutical companies offer patient assistance programs that provide medication at a lower cost or even free of charge.
- You might consider enrolling in a clinical trial, where the trial company pays for the medicines.
- You can also ask your doctor or pharmacist about online pharmacy options.
How Can I Deal with My Long-Term CML Care?
Knowing what to expect both medically and financially during treatment will help you to plan ahead and make you feel more prepared. By talking with your doctor, financial navigator, and insurance provider you will be well-informed of your benefits and focus your journey on what matters the most-getting better.
Consider the following steps to manage the cost of your CML treatment:
- Choose an in-network provider.
- Do some homework and call your insurance provider to see what's covered.
- Shop around and call different pharmacies to find the best price.
- Ask your doctor if there are alternatives for your current TKI drug.
- Check if you need pre-approval or pre-certified letter for your health insurance.
- Check coverage for emergency care, hospitalization, and ER visits.
- Work with a social worker or clinic financial navigator who can help establish payment plans and assist you with grants/aid for your treatment center.
Questions to Ask Your Doctor
- What will my treatment cost? Will my treatment be covered by my medical insurance?
- How often do I need to take TKI and for how long?
- How often will I need to be monitored?
- What kinds of tests or procedures do I need in the future?
- What options do I have if I can't afford my medication?
- Can you recommend a financial counselor or navigator to talk with?
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