Biotechnology Healthcare - November/December 2008 - (Page 41) Copayment Foundations: Help for the Underinsured BY TINA SHAH, MD With focus often placed on the uninsured, many patients who are underinsured fall through the cracks. Copayment foundations look to fill their gaps in coverage. H ealthcare is an everyday topic of discussion in the media, and although discourse typically centers on which coverage strategies will be most effective — e.g., increased spending to provide universal coverage versus a shift in authority to the private sector — the plight of the insured often is overlooked. The fact is that the insured often are underinsured, and the number of Americans in this position is expected to continue to grow. Why is it that the insured often find themselves struggling to pay for treatment, and sometimes are at a greater disadvantage than those with no insurance? Ironically, one reason is due to advancements in medicine. In the past decade, the biotechnology field has soared with novel drugs for treating numerous diseases, but with that came considerably higher health insurance premiums. Employers found themselves stuck in the middle; the technology to treat their employees had been developed, but the price of therapy and the cost of good health insurance were too great. That re- sulted in cost shifting and considerably higher out-of-pocket costs for patients. To meet the need for alternative funding, copayment foundations (CFs) were created to serve as a band-aid on a wounded and inadequate healthcare system. Tina Shah, MD, is a resident in Internal Medicine at Thomas Jefferson University Hospital, in Philadelphia. She can be reached at «Tina.Shah@ jeffersonhospital.org». when therapy is changed. The return on this short-term assistance can be astounding for employers, who experience less absenteeism and employee turnover when experienced workers stay healthy and on the job. The CF movement arose due to a combination of changing government laws and expensive biotechDISEASE-BASED nological advances. The ASSISTANCE field of oncology was affected most significantly CFs have been in exiswith the emergence of tence since the late 1980s, biotherapeutics to treat but have been largely uncancers. Given the highly derused due to lack of disparate out-of-pocket knowledge about their costs compared to other existence. Yet they have diseases, insured cancer great potential benefit to Tina Shah, MD patients struggled finanemployers. As the name implies, CFs provide financial as- cially. Oncologists subsidized treatsistance for copayments (and some- ment costs with the help of the phartimes, other expenses) to patients maceutical industry as they with diseases with high therapeutic increasingly prescribed a comcosts, including cancers, chronic pany’s product for more patients. disorders, and rare conditions. Un- This practice became illegal when like a pharmaceutical-sponsored pa- the U.S. government enacted the tient assistance program that is lim- Medicare and Medicaid Patient Proited to those who have no insurance tection Act of 1987. The “antikickand to treatments manufactured by back statute” made it a criminal ofa specific company, CF charities are fense to knowingly and willingly disease-based. Patients can obtain offer payment, to solicit, or to reassistance for first-line treatments ceive any remuneration in reward regardless of manufacturer, can re- for referrals that are reimbursable by ceive aid for multiple drugs from a federal healthcare program. Pharone organization, and can benefit maceutical companies thus were enfrom a seamless transfer of funds couraged to make donations to notNOVEMBER/DECEMBER 2008 · BIOTECHNOLOGY HEALTHCARE 41
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