1 / 13

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. Agenda. The Under-Insurance Problem A Changing Healthcare Environment Impact of Changes on Co-Pay Assistance Needs. How Big is the Problem?.

laith-lopez
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Growing Need for Co-Pay Assistance The National Congress for the Un and Under Insured September 2008

  2. Agenda • The Under-Insurance Problem • A Changing Healthcare Environment • Impact of Changes on Co-Pay Assistance Needs

  3. 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 NOTinclude the millions of Americans over 65 who are under-insured, have Medicare , but no supplemental insurance, or have no insurance at all.

  4. Healthcare Costs Are Increasing Source: 2008 Milliman Medical Index

  5. The Impact of Being Underinsured Source: Commonwealth Fund Biennial Health Insurance Survey

  6. Why Co-Payment Assistance? Pharmacy cost trends upward exceeded all other components of medical care from 2007 - 2008. Source: 2008 Milliman Medical Index

  7. 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 Source: 2008 Milliman Medical Index

  8. 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 • Bottom Line: The need is increasing. Source: Co-payments for Expensive Drugs Soar, The New York Times, April 14, 2008 and 2008 Milliman Medical Index

  9. Patient Access Network • 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. • Dedicated to improving access to needed health services for insured patients who cannot afford the out-of-pocket costs associated with their treatment.

  10. Patient Access Network Supports the Under-Insured Approvals by Income Level 2 times the Federal Poverty Level for a Household of 4 is $42,400 per year. Co-payment assistance is not just for the indigent. It is for patients who might not get life-saving treatments because of the expense. Source: Patient Access Network Data, 2004 - 2007

  11. The Need for Co-pay Assistance from PAN is Increasing Projected 2008 Demand is increasing by over 30% each year, while revenues remain stable Source: Patient Access Network Data, 2004 - 2007

  12. 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

  13. 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.

More Related