Help for Low-Income and Uninsured Patients

A Diagnosis of cancer is daunting enough, but for many low-income patients, who are uninsured or underinsured, learning the cost of treatment, including lifesaving drugs, can create a barrier to patients receiving treatment.

When the high cost of drugs is the barrier, Lori Dowdy often has a solution before patients come for their first appointment. Dowdy runs the Johns Hopkins Patient Assistance Program Medication Access Team and works with patients’ doctors and social workers to get ahead of the problem.

“We take a proactive approach,” she says. “Before the patient is made aware of the costs, we have already gotten the medicines approved and gone through the steps to have them ready for the patient.”

She and her team have helped more than 1,200 cancer patients obtain medications by working directly with the pharmaceutical companies that make the drugs, foundations and other grant providers to cover costs.

“If you’re a patient who is already on a limited income, it’s hard to fathom a $10,000 pharmacy bill,” says Dowdy. “Without this help, we know many patients would have to choose between purchasing their medications and buying groceries to feed their families. Many patients would go without their medications.”

The high cost of drugs can also be a problem for middle-class families who have insurance, and Dowdy also works to reduce the cost of medications for these families.

They primarily help patients with outpatient medications, but she and her team have also been successful on the inpatient side, acquiring drugs given by IV infusion.

“Too many patients are more concerned about the costs of care than getting well,” she says. “It’s an amazing opportunity for us to talk to patients who are worried about their families and how they are going to pay for medications, and to reassure them that it’s all taken care of.”

Beyond medications, patients without insurance, or enough insurance, worry about how they will pay hospital and doctors’ bills. Kimmel Cancer Center Harry J. Duffey Family Patient and Family Services Program social workers work with the clinical team to help patients who face financial or other challenges to accessing cancer care.

Genitourinary cancer expert Michael Carducci and colleagues recently had four young men present in the clinic with advanced testicular cancer. One patient had some insurance, but the others were uninsured.

Carducci, who oversees clinical research at the Kimmel Cancer Center, engaged the help of social worker Marianne Jones. The prognosis is good for testicular cancer, says Carducci, but the care, particularly with advanced disease, involves chemotherapy and surgery. “Cure is still possible, but it requires more therapy,” he says.

Research shows that where cancer patients get treated makes a difference, with academic centers of excellence, like the Kimmel Cancer Center, offering the best outcomes. With this in mind, Carducci worked with Jones to identify resources available to these patients. These include services offered by Johns Hopkins that are specifically directed at low-income and underserved patients, but also external resources social workers may explore to help patients.

She and her colleagues explore Medicaid, other medical assistance programs and opportunities to obtain low-cost insurance through state exchanges. They may also connect patients with pharmacies that fill prescriptions for low-income patients at significantly reduced costs and often can assist with transportation to appointments. Doing all they can to help patients in need can be a complex and laborious process for Dowdy, Jones, Carducci and others at the Kimmel Cancer Center, but it’s one they embrace.

“We do our best to make sure patients have a safety net,” says Jones.

While some of the young men still have more treatment ahead, currently they are all doing well, and Carducci is optimistic that their cancers can be cured.