title: The Role of Patient Financial Assistance Programs in Reducing Costs for Cancer Patients.
abstract: BACKGROUND
  Limited transparency exists regarding eligibility and benefits for patient financial assistance programs (PAPs).
  
  
  OBJECTIVE
  To describe oral anticancer medication costs, insurance coverage, and the degree of financial assistance provided by PAPs.
  
  
  METHODS
  This was a retrospective study of prescription anticancer medication costs and PAP coverage. The study used data from an academic cancer center's specialty pharmacy. Medication, cost, and coverage data were collected from the specialty pharmacy database for prescriptions filled from January 2013 to November 2015. Prescriptions with missing copayments, insurance, or financial assistance amounts were excluded. Descriptive statistics summarized prescription characteristics.
  
  
  RESULTS
  Of 9,388 anticancer medication prescriptions filled, 8,212 (87%) had complete cost data and were included. The 5 most common medications prescribed were capecitabine (20%), temozolomide (13%), enzalutamide (10%), letrozole (6%), and tamoxifen (4%). Most prescriptions were covered by commercial insurance or Part D (41.6%, n = 3,418). The median copayment was $20 per prescription (interquartile range [IQR] = $10.00-$80.30). When considering all prescriptions that received PAP assistance, the median amount of financial assistance provided by PAPs per prescription was $411.0 (IQR = $302.80-$523.40), amounting to 15% of the median prescription cash price. When considering all prescriptions, the median amount of financial assistance provided by PAPs per prescription was $0, and the mean was $79.30 (SD = $389.90).
  
  
  CONCLUSIONS
  A minority of prescriptions received financial assistance from PAPs. The proportion of financial assistance was small relative to the price billed to insurance. PAPs play a modest role in reducing anticancer prescription-related costs.
  
  
  BACKGROUND
  Support of this project by The Duke Biostatistics Core was made possible by Grant Number UL1TR001117 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Zullig is supported by a VA Health Services Research and Development (HSR&D) Career Development Award (CDA 13-025). Zullig also reports a financial relationship with Novartis. Zafar reports financial relationships with Novartis, Genentech-Roche, and Vivor. Vlastelica, Shankaran, and Wolf have nothing to disclose. The views in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, Duke University, NCATS, or NIH. This abstract was previously presented at the 2016 ASCO Annual Meeting; Chicago, Illinois; June 3-7, 2016. Study concept and design were contributed by Zafar, Zullig, and Vlastelica, with assistance from Shankaran. Vlastelica and Wolf took the lead in data collection, along with Zafar, and data interpretation was performed by Zullig, Zafar, and Wolf, along with Vlastelica and Shankaran. The manuscript was written and revised by Zullig and Zafar, along with the other authors.
authors.affiliation: 1 Durham Center for Health Services Research and Development in Primary Care and Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.affiliation: 2 Department of Biostatistics and Bioinformatics.
authors.forename: Steven
authors.initials: S
authors.lastname: Wolf
authors.affiliation: 3 Department of Pharmacy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Vlastelica
authors.affiliation: 5 Division of Medical Oncology, Department of Medicine, University of Washington, Seattle.
authors.forename: Veena
authors.initials: V
authors.lastname: Shankaran
authors.affiliation: 4 Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: S Yousuf
authors.initials: SY
authors.lastname: Zafar
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D003363:Cost Control; D016527:Drug Costs; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008483:Medical Assistance / Q000191:economics* / Q000706:statistics & numerical data; D009369:Neoplasms / Q000188:drug therapy / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000970:Antineoplastic Agents