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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?.

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

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  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.

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