Intervention reduced access delays for oral oncology medications in Medicare patients, highlighting financial advocacy.
198 Background: Access to oral oncology medications is often hindered by high insurance deductibles, particularly for Medicare and Medicare Replacement plan holders. At St. Luke’s University Health Network, patients unable to afford their deductibles experienced significant delays in receiving necessary treatments. In response, the Medicare Prescription Payment Plan (MPPP) was introduced as an intervention aimed at improving timely access to medications by spreading deductible costs over monthly payments, eliminating upfront expenses, and ensuring pharmacy access without direct patient payment. Methods: To enhance patient participation and effectiveness, the intervention included direct outreach efforts, where patients were contacted proactively to assess their financial situation. The Oncology Financial Advocacy (OFA) team conducted thorough reviews of out-of-pocket costs for all prescribed medications, ensuring patients understood their financial responsibilities. Additionally, the team provided education on the MPPP program, discussing affordability and enrollment options to support informed decision-making. Results: The initiative set a goal to reduce medication access delays by 50%, corresponding to an average reduction of 10 days and a median reduction of 7.5 days. Outcomes demonstrated that patients utilizing MPPP obtained their medications significantly faster than those relying on manufacturer free drug programs alone. The average time to receive medications through MPPP was 4.5 days, compared to 14.8 days for free drug recipients. When both programs were combined, patients experienced a total average wait time of 8.46 days, representing an 11.14-day reduction (56.8%). Despite these improvements, several limitations persisted, including patient follow-through, manufacturer delays, and procedural requirements that mandated MPPP enrollment before free drug submission. The program’s broader impact showed an overall average reduction of 5.31 days (27%) across the patient population, demonstrating measurable success in reducing access barriers. Conclusions: These findings highlight the importance of financial advocacy, proactive patient engagement, and structured payment plans in mitigating medication delays, ensuring more equitable and timely treatment for oncology patients.
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Pöllinger et al. (2025) studied this question.
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