Patient financial advocacy
Medicare Part D Restructure Gives CMS the Ability to Negotiate Drug Prices
Health care consumes an inordinate amount of the U.S. gross domestic product at 18.3%. In 2021, healthcare spending increased by 2.7% to $4.3 trillion, equating to $12,914 per person annually. Under that average, prescription medications are the highest expenditure. According to the Centers for Medicare and Medicaid Services, “Retail prescription drug spending increased 7.8% to $378.0 billion in 2021, a faster rate than in 2020 when spending increased by 3.7%. The acceleration in growth was due to an increase in the use of prescription drugs in 2021.” On top of that staggering national economic impact are the personal, emotional, and familial burdens that take a toll on patients and caregivers.
Meet the Advocate Who Helped Pass the Lymphedema Treatment Act
Coming to you from Congress®, we get to know the 2023 ONS President's Award recipient, Heather Ferguson, the founder and executive director of the Lymphedema Advocacy Group. Ferguson had a pivotal role in advocating with ONS for the Lymphedema Treatment Act, which was finally passed into law in December 2022 and improves access to care for patients and survivors.
United States Lags Behind Other Nations in Health Care
Despite Americans spending more for health care than other high-income countries, the United States has the highest rates of death for avoidable or treatable conditions, maternal and infant mortality, and suicide, researchers reported in an analysis study published in January 2023 by the Commonwealth Fund.
Patients With Cancer Save More Than $150 Per Visit When Using Telehealth
Between travel time and expenses, missed work hours, and other factors, cancer care visits cost patients more than just a copay. A new study quantified the financial benefits of conducting those visits via telehealth versus in person, with researchers reporting that patients saved more than $150 in expenses and three hours in travel and waiting time per visit by using telehealth. They published their findings in JAMA Network Open.
Uninsured Rate at an All-Time Low After 2022 HealthCare.Gov Insurance Enrollment Breaks Records
Almost 11.5 million people signed up for healthcare insurance on HealthCare.gov from November 1–December 15, 2022, President Joe Biden announced in December 2022. Enrollment increased 18% over the same period in 2021.
Oncology Providers Can Transform the Trajectory of Financial Toxicity
The complexity of cancer care may affect patients’ financial toxicity more than we’ve realized. Many patients struggle with the economic burden of out-of-pocket spending for cancer care, including insurance copayments, transportation, and reduced income, as well as their psychological burden of worry and coping with less funds for food and medications. Multimodality treatments, maintenance and ongoing therapies for metastatic disease, and geographic factors such as travel for clinical trials and specialized services or paying for out-of-network care can put patients’ finances in a deeper hole. The adverse implications are significant: decreased quality of life, increased anxiety and depression, lower adherence to prescribed medications and oncology care, and reduced survival.
Healthcare Economics Through the Inflation Reduction Act of 2022 and Beyond
Sick. Americans are literally sick of the financial burden vulnerable patients endure because of high out-of-pocket, healthcare-related costs. The complicated and convoluted issue has no easy solution.
The Case of the PARP Inhibitor Adherence Assistance
Mei is a 67-year-old patient who recently underwent an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and tumor debulking. Her surgical specimens were sent for pathology review and germline biomarker testing. Based on the findings, Mei was diagnosed with stage IIIC, high-grade serous epithelial ovarian cancer with a BRCA1 pathogenic germline variant.
New Cancer Drugs Launch at Record-High Prices
Inflating more than 50% since 2017, the annual price of newly launched cancer drugs averages $283,000 in 2022, according to a new report from the office of U.S. Representative Katie Porter (D-CA). Although new drugs for any condition are also seeing record-breaking high prices, the cost of new anticancer therapeutics is 3.7 times higher than that of non-oncology drugs.
Even During Routine Cancer Care, Financial Hardship Significantly Increases Mortality
Patients with cancer experiencing financial hardship during routine care are nearly 1.5 times more likely to die than those who aren’t, researchers reported in study findings published in JCO Oncology Practice.
HRSA-Funded Health Centers and NCI-Designated Cancer Centers Partner to Improve Equity in Cancer Screening
The U.S. Department of Health and Human Services, through the Health Resources and Services Administration, awarded more than $5 million in September 2022 to 11 HRSA-funded community health centers to help underserved populations access cancer screenings and early detection services in partnership with National Cancer Institute-designated cancer centers.
Inflation Reduction Act Lowers Medicare Advantage and Prescription Drug Plan Premiums in 2023
Under the Inflation Reduction Act, patients will pay lower premiums for the Medicare Advantage and Medicare Part D prescription drug plans during the 2023 coverage year, the Biden-Harris administration announced in September 2022. People with Medicare prescription drug coverage will also receive better and more affordable benefits, including a $35 cost-sharing limit on covered insulin product and coverage for adult vaccines recommended by the Advisory Committee on Immunization Practices.
Biden-Harris Administration Make Largest Investment Ever in Navigators for 2023 Open Enrollment Period
Making history as the single largest Navigator organization funding award provided to date, the U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, invested $98.9 million in grant funding to 59 Navigator organizations in August 2022 to help consumers navigate enrollment and make health coverage more accessible.
CHIP Drastically Reduced Uninsured Children in the Past 25 Years
The Children’s Health Insurance Program helped drop the percentage of uninsured children from 15% to 3.7% since its authorization by Congress in 1997, according to data from the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services released in celebration of CHIP’s 25th anniversary in August 2022.
Senators Cantwell, Grassley Introduce Bipartisan Bill to Battle Unfair Drug Pricing
Patients with cancer and other healthcare consumers would receive reinforcements in the fight against financial toxicity with new legislation that would “empower the Federal Trade Commission (FTC) to increase drug pricing transparency and hold pharmacy benefit managers (PBMs) accountable for unfair and deceptive practices that drive up the costs of prescription drugs.” U.S. Senators Maria Cantwell (D-WA) and Chuck Grassley (R-IA) introduced the proposed bill in May.
U.S. Supreme Court Dismisses Cases on Medicaid Requirement to Work
A pandemic is not the time to experiment with Medicaid work requirements, the Biden-Harris administration maintained in April 2022 when it urged officials in Arkansas and New Hampshire to cancel their U.S. Supreme Court hearing appeals regarding the Trump administration orders and send the matter back to the U.S. Department of Health and Human Services (HHS) for further action.
COVID-19 Contributes to Climbing Costs of Cancer Care
Cancer is one of the top five most expensive healthcare conditions to treat, costing the United States more than $157 billion annually. The payout from patients’ pockets may be even greater, with the cost of cancer medications alone standing at $895 billion per year. But paying for cancer during a pandemic? Even financially secure patients with healthcare coverage are struggling.
Even Insured Patients With Advanced Cancer Experience Financial Toxicity
As many as 71% of patients with advanced cancer—most of whom have healthcare insurance—experience major financial hardship because of their disease, according to study findings published in the Journal of the National Cancer Institute.
CMS Takes Action to Lower Out-of-Pocket Medicare Part D Prescription Drug Costs
Out-of-pocket prescription drug costs for beneficiaries with Medicare Part D could start to lower with improved price transparency and market competition thanks to a January 2022 proposed rule from the Centers for Medicare and Medicaid Services (CMS). The rule, which would take effect on January 1, 2023, would improve beneficiaries’ experiences with Medicare Advantage and Medicare Part D and work to improve health equity in the programs, according to CMS.
Marketplace Policy Changes Increase Access for Healthcare Coverage in 2023
Consumers will more easily find affordable healthcare coverage in 2023, thanks to the Biden-Harris administration’s December 2021 Notice of Benefit and Payment Parameters 2023 Proposed Rule, according to the U.S. Department of Health and Human Services’ (HHS) Centers for Medicare and Medicaid Services (CMS). The rule also improves shopping for healthcare coverage, establishes rules to ensure people have access to care, and advances health equity for consumers purchasing Marketplace coverage.
White House Initiative Addresses Disparities for Asian Americans, Native Hawaiians, and Pacific Islanders
Advancing equity, justice, and opportunity for Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) communities in the United States requires an ambitious, whole-of-government agenda, the U.S. Department of Health and Human Services (HHS) announced in December 2021. To drive that agenda, the agency launched the Biden-Harris administration’s White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders (WHIAANHPI).
No Surprises Act Protects Patients From Unexpected Medical Bills
Patients now have protection against unexpected—and often extraordinarily high—medical bills. On January 1, 2022, the Biden-Harris administration’s bipartisan No Surprises Act went into effect to ban surprise billing in private insurance for most emergency care and many instances of nonemergency care, according to the U.S. Department of Health and Human Services (HHS).
Families See Increase in Healthcare Premiums, Increase in Covered Services
Employer-sponsored health insurance premiums increased by 4% for families in 2021, bringing the average annual cost to $22,221 per family, according to the results of a benchmark Kaiser Family Foundation (KFF) Employer Health Benefits survey released in November 2021. KFF also assessed the COVID-19 pandemic’s impact on workplace health benefits, including telemedicine and mental health services.
Legislators Want Medicare to Negotiate Drug Prices to Improve Access and Affordability
Few political and policy issues resonate with all Americans as much as the costs of prescription medications, particularly those for acute and chronic diseases that affect the body and spirit, like cancer. Seizing the opportunity for real change, in August 2021 President Joe Biden made a major announcement about his administration’s intent to change the dynamic on the financial impact of drugs and government oversight.
HHS Secretary Releases Proposal to Lower Prescription Drug Costs
On September 9, 2021, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra released the Drug Pricing Plan to combat excessive pricing or prescription drugs and reduce the prices paid by the federal government for such drugs, and to address price gouging in the industry. The plan is a part of an initiative from President Biden’s executive order on Promoting Competition in the American Economy to advance the federal government’s ability to address overconcentration, monopolization, and unfair competition in the economy.
6.8 Million Individuals Enroll in CHIP Prior to Program’s 24th Anniversary
U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra celebrated the Children’s Health Insurance Program’s (CHIP’s) 24th anniversary on August 4, 2021, a program that “for more than two decades, has been a lifeline for millions of children and families across America,” with an incredible announcement: in 2020 and 2021, CHIP provided more than 6.8 million enrolled individuals with coverage during the COVID-19 coronavirus pandemic.
American Rescue Plan Lowers Costs for More Than 1.5 Million Americans During Special Enrollment Period
When President Biden signed the American Rescue Plan Act of 2021 into law in March 2021, the administration began working to make improvements in areas such as access and affordability by increasing eligibility for financial assistance. The new law lowered premiums for most people who currently had a Marketplace health plan and expanded access to financial assistance for more consumers, and data published in July 2021 showed that from February 15–June 30, 2021, more than 1.5 million Americans signed up for new health insurance coverage using the 2021 Marketplace Special Enrollment Period (SEP).
CMS Final Rule Improves Health Equity, Access to Treatment, Hospital Readiness, and More
To achieve value-based, person-centered care, the U.S. healthcare system must promote sustainability and readiness to prepare for future public health emergencies such as the COVID-19 coronavirus pandemic, the Centers for Medicare and Medicaid Service (CMS) said. In August 2021, CMS announced that the Hospital Inpatient Prospective Payment System and Long Term Care Hospital Prospective Payment System final rule will take effect on October 1, 2021, in support of that work.
Biden-Harris Administration Issues Actions to Prevent Surprise Billing
In July 2021, the Biden-Harris administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury and the Office of Personnel Management, issued the Requirements Related to Surprise Billing interim final rule to restrict surprise billing. The rule applies to billing for patients in job-based and individual health plans who obtain emergency care, nonemergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
ACA Provides Healthcare Coverage to 31 Million Americans
Approximately 31 million Americans now have healthcare coverage through the Affordable Care Act (ACA), according to a June 2021 issue brief from the office of the assistant secretary for planning and evaluation (ASPE). Of those, 11.3 million consumers were enrolled in Marketplace plans, 14.8 million people were newly enrolled in Medicaid, 1 million individuals were enrolled in ACA’s Basic Health Program option, and nearly 4 million previously eligible adults gained coverage under the Medicaid expansion due to enhanced outreach and increased federal funding. Additionally, insurance rates have fallen across the country since the law’s implementation 11 years ago.
Patient Advocate Groups Challenge Medicaid Engagement Requirements
The American Cancer Society, along with 14 other healthcare groups advocating for increased access to care, filed an amicus curiae—Latin for “friend of the court”—urging the U.S. Supreme Court to deny state imposition of engagement requirements, like monthly community service, for Medicaid beneficiaries. The U.S. Supreme Court is likely to spend spring deliberating and convey a judgment before the end of summer.
ACA Medicaid Expansion Improves Health and Increases Access to Care for Young Adults
The rate of uninsured young adults (aged 19–25) fell by more than one third between 2009 and the first quarter of 2014 following the Affordable Care Act’s (ACA’s) Medicaid expansion, according to a February 2021 report from the Urban Institute. With the expansion, young adults also reported improved overall health, increased access to care, and fewer high out-of-pocket costs.
WHO Campaigns for Global COVID-19 Vaccine Equity
More than 800 million COVID-19 coronavirus vaccine doses have been administered worldwide. However, 54% of those have been in high-income countries, which contain only 19% of the world’s population, whereas lower-middle income countries have only 33% of the vaccines for their 81% of the population. Those disparities have serious implications and limit equal access to health care, including vaccinations. The World Health Organization (WHO) is campaigning to address vaccine inequity on a global scale.
Biden’s American Rescue Plan Targets Social Determinants of Health and Other Disparities
The Biden administration’s American Rescue Plan (APR) is the largest, single piece of legislation focused on economics since Franklin D. Roosevelt proposed in his New Deal programs to pull the United States out of the Great Depression. Sweeping in scope, two of APR’s goals are to make health care accessible for all and to create formal plans for addressing racial disparities.
CMS Changes to Medicare Prescription Coverage Could Affect Patient Care
From Teddy Roosevelt to JFK, presidents throughout history have sent legislation to Capitol Hill with the intent to expand healthcare coverage to more Americans. Finally, when Lyndon B. Johnson drafted a bill and pushed it through Congress by expanding sections of the Social Security Act, Medicare become an entitlement and is now implemented by the Centers for Medicare and Medicaid Services (CMS). During the past 50 years, federal health coverage has grown to include Medicaid, maternal and childcare assistance, public health programs, and prescription medication pricing.
Billing and Coding Breakdown Helps Nurses Recognize the Realities of Reimbursement
Understanding correct coding strategies is an important skill that affects billing and reimbursement for value-based cancer care. Meeting the requirements for complete and accurate documentation is critical to support healthcare claims. Both nurses and advanced practice providers have responsibilities in this work.
Oncology Nurses Have a Responsibility to Manage the Financial Toxicities of Cancer
Cancer is one of the most expensive medical conditions to treat, and patients are expected to pay more and more out of pocket. Costs often lead to financial toxicity, defined as “distress or hardship arising from the financial burden of cancer treatment,” according to Darcy Burbage, DNP, RN, AOCN®, CBCN®, who discussed the topic in a session for the inaugural ONS Bridge™ virtual conference.
Mylan Patient Specialists Help Support Patients Through Biosimilar Cancer Treatments
Mylan understands that you care about your patients and that this may be a difficult time for them. Now more than ever, additional treatment options, such as biosimilars offerings may play an important role in providing patients access to medications they need.
President Trump Issues Executive Orders on Prescription Drug Pricing
In July 2020, U.S. President Donald Trump issued four executive orders to provide solutions to the ever-increasing price of prescription medications. One of the top domestic issues in healthcare is the price of prescription medication, particularly those deemed lifesaving, such as insulin for diabetics and drugs for patients with cancer.
Healthcare Worker Shortage; Trump Clashes With Big Pharma; Surprise Billing
Houston, TX, Miami, FL, and Baton Rouge, LA, are three of the many cities battling repercussions from the COVID-19 coronavirus pandemic. Most daunting is the perpetuated shortage of healthcare workers as the pandemic continues to ravage the United States.
Trump Uses Executive Orders to Lower Drug Pricing
As one of the only not-entirely-pandemic-related health policy topics currently in policymakers’ discussions, lawmakers are again revisiting the high cost of prescription drugs. Voters have voiced concerns in the current economic climate, and, eager to appease in the months before the November presidential election, the Trump administration responded.
Nurse-Turned-Policymaker; Prescription Drug Reform; Safer Working Conditions
As one of the youngest members of the 2018 freshman congressional class, U.S. Representative Lauren Underwood (D-IL) has already made quite a name for herself. Eschewing, for the most part in this heightened environment, partisanship and instead concentrating on health and economic issues, the representative champions access and affordability for all Americans.
CMS Grants Waivers to Providers During COVID-19 Public Health Emergency
In emergencies such as the COVID-19 coronavirus pandemic, government health agencies have the authority to grant waivers for various federal health programs. Starting on March 23, 2020, the Centers for Medicare and Medicaid Services (CMS) waived certain requirements and protocols for providers and beneficiaries.
Prescription Drug Proposal; COVID-19 Safety Legislation; Drug Costs Outpace Inflation
Drug pricing is a top legislative issue for Congress, and amid rising COVID-19 concerns, health policy topics are more pressing than ever. On March 5, Senator Martha McSally (R-AZ) introduced the Lowering Prescription Drug Prices for America’s Seniors and Families Act of 2020, which would allow Medicare to negotiate prices after a drug’s patent expires as well as cap out-of-pocket prescription spending for seniors at $3,100 per year.
How Oncology Nurses Can Support Patients During Financial Toxicity
As groundbreaking yet high-cost cancer treatments make their way into clinical practice, the effects of financial toxicity can put a damper on the profound effects that new, lifesaving medications can have on patients with cancer. It’s a problem that even Washington, DC, hasn’t been able to address—so what can oncology nurses do about it?
Congress Tackles Surprise Billing for Patient Access to Affordable Care
A patient is rushed to the emergency room, diagnosed, and taken to surgery immediately. The patient recovers, but weeks later a bill arrives beyond any expectation, and too often ability, to be paid. This practice has become so routine that it has its own name: balance billing or, more commonly, surprise medical billing. It strikes many Americans with the burden of their ailment once again.
HHS Announces Safe Importation Action Plan for High Medication Costs
The high cost of prescription medications—often lifesaving drugs—has become an unsustainable burden for many American patients. It’s a central topic in the healthcare conversation and a complex issue with countless moving parts. National opinion polling finds that a majority of people want to see changes in drug pricing.
The Battle Against Drug Pricing Wages On
Few know the power that prescription medications have on the quality of life for patients more than nurses. In more than just physical ways, access to affordable drugs is essential to patient-centered care and emotional, psychological, familial, and even financial stability. For too long, the cost and availability of medicines have been barriers to health care, rather than opportunities for survivorship.