Prescription Drug Coverage: New Recommendations from the National Association of Insurance Commissioners

As someone dealing with cancer, you are probably no stranger to the exorbitant costs of triage-cancer-blog-rx-drugs-naicprescription drugs.  In fact, the cost of all drugs, not just cancer drugs, has received quite a bit of news coverage lately. Everyone admits there is a problem, but very few have identified any solutions.  Now, the National Association of Insurance Commissioners (NAIC) has done just that.  At the NAIC’s summer meeting in August, a report was issued with a list of recommendations for state and federal policymakers to improve access to affordable prescription drugs.

Key Recommendations:

  • Limit consumer out-of-pocket costs, by, for instance, prohibiting co-insurance for prescription drugs
  • Prohibit insurance companies from changing their formulary mid-year, if it negatively affects enrollee access to drugs
  • Limit the number of drug tiers that insurers can use
  • Require formularies to be updated weekly and include information about drug tiering, the actual dollar amount of any cost-sharing, any utilization management or network restrictions, and the process to request a drug exception, among other information
  • Adopt standardized plans with meaningful cost-sharing limits to lessen the effects when an insurance company uses drug tiers
  • Collect standardized, plan-level data to enable the development of consumer tools and apps
  • Solicit feedback from external stakeholders—such as advocates, other state agencies, ombudsmen, and independent medical experts—to inform the formulary review process.

Frustratingly, these recommendations won’t translate into meaningful change for quite some time.  Still, without consumer advocates starting the conversation about reform, change would never happen.

Cancer in the News

What does the Affordable Care Act (ACA), race/ethnicity, and the 2008 economic recession have in common? They have all had an impact on the cancer community.

ACA Saves California Families $2,500 on Health Care

Ever since the ACA’s premium tax credits and cost-sharing subsidies took effect in 2014, Triage Cancer Blog Cancer in the Newsthe health care reform law has received severe criticism in the news media. Yet a recent study from the California Health Care Foundation shines a different, more positive light on the impact of the health care law. New data shows that median annual out-of-pocket spending for families with individual health insurance coverage has dropped nearly $2,500. This drop in spending is attributed to increases in consumer protections and coverage in the policies sold through the state health insurance marketplaces under the ACA. Although this study was specific to California, national health care spending has declined as well. For more information about the Affordable Care Act and how it impacts the cancer community, read our Quick Guide on Health Insurance.

The Deadly 2008 Recession

The 2008 economic collapse was a dark time for the world, as it caused many companies to lay off workers, who in turn were left unemployed and in debt. A new study has found that the 2008 recession also caused an additional 260,000 cancer deaths worldwide. The increased deaths are largely attributed to the US and Russia, both countries in which employers or individuals have to pay for their healthcare. On the other hand, countries with universal health coverage, like Britain, saw no additional cancer deaths between 2008 and 2010. This is because people in Britain, employed or not, had health insurance whereas many unemployed Americans and Russians either faced poor or delayed treatment, were diagnosed late, or couldn’t afford medical attention altogether. But it’s important to note that although the UK and other countries with universal health coverage did not experience an increase in deaths, they still underwent a significant rise in unemployment. This forced many countries into cutting their spending on health care. Ultimately, the impact a financial downturn has on the economy trickles down to cancer patients, for a reduction in government spending can impact access to care and impact cancer survivorship.

Intersectionality in the Cancer Community: Hispanic and Black Young Adults More Likely to Die of Their Disease Than White Counterparts

According to a study conducted by the University of Colorado Cancer Center, black and Hispanic cancer patients, between the ages of 15 and 29, have an increasingly higher risk of mortality than same-aged white cancer patients. This disparity is largely explained by one’s socioeconomic status and access to financial resources. However, even after holding insurance status constant, the scientists found the same discrepancies among the race/ethnic groups. The study therefore suggests that race/ethnicity is not only independent of socioeconomic status, but also that race/ethnicity plays an independent role in mortality. Additionally, this demonstrates that intersectionality among patients is in fact a lived reality in the cancer community. Meryl Colton, a medical student at the University of Colorado School of Medicine, says that “Knowing that a disparity exists allows us to ask questions that can help ensure everyone receives the best possible care.” Now the focus can turn to identifying those questions and finding the right answers to them.

Cancer & Finances: Thinking Outside the Box

By Michael Wolfe, Fifth Season Financial

Your cancer doesn’t own you, but when a diagnosis is coupled with financial stress, sometimes it may feel that way.FLAG logo with tag

If you’re struggling to keep your finances in order after your cancer diagnosis, you are hardly alone. The numbers can be staggering:

  • New research from the University of Wyoming revealed that family income declines by an average of 20% in the first year after diagnosis
  • Work hours among that group declined by about 200 hours, or five full weeks
  • At the same time, costs for cancer medications have skyrocketed, with newly-approved drugs costing more than twice what they did only a decade ago
  • As a result, cancer patients are more than 2.5 times more likely to file for bankruptcy than the average individual

Experiencing financial stress is a huge impediment to treatment and recovery. An important first step after a cancer diagnosis is to do a complete financial assessment. It may seem easy to put off with so much happening with your medical condition, but understanding your assets and the costs that are to come will benefit you in the months ahead.

Later this year, Triage Cancer and Fifth Season Financial will be releasing a new guide, “Navigating Finances After Cancer,” to help people deal practically and efficiently with the financial stress associated with a cancer diagnosis. The guide will help you assess your current situation and find options for assistance that are right for your individual needs.

But why wait? Making a budget spreadsheet is something we always think about but rarely make the time for. Now is the time to get your finances in order!!

Here are items to consider as you put your assessment together:

  • MONTHLY INCOME – include your gross monthly salary, and the salaries of your spouse or other working family members that may be supporting you during your treatment. It’s especially important to talk to your doctors or social workers about what to expect moving forward, and how it might affect your ability to work. If you anticipate an impact on your monthly income, best to factor it in now.
  • NON-MEDICAL BENEFITS – include anything that you currently or may ultimately qualify for in the immediate future: public assistance, unemployment, social security, alimony, disability, etc.
  • MEDICAL COVERAGE – make sure you’re talking to a social worker (or a financial navigator if you have access to one) to ensure that you’ve got the best possible coverage for the treatments and drugs that you’ll need. There may be changes you can make that could dramatically change your medical expenses moving forward.
  • YOUR EXPENSES – be thorough in understanding your true monthly costs. Make sure to include mortgage or rent, gas & electric, car payments and insurance, food, telephone, education and any other expenses that you can expect. Be honest about your spending and account for quality of life needs that can help you through your treatment.
  • LIFE INSURANCE – there are sources of real funds that you may not realize you can access. Did you know you may be able to receive some of your life insurance benefit early? Companies like Fifth Season Financial (through their FLAG – Funds for Living And Giving program) can provide cash advances to patients based on the face value of their life insurance policy, regardless of type of policy (group, life, whole, FEGLI, etc.). These advances are not repaid during their lifetime…instead, the advance is repaid later out of the remaining proceeds in the life insurance policy. But in most examples (90% of Fifth Season’s cases to date), funds still remain to pass on to beneficiaries. So your life insurance policy can be an important item to have on your asset list. Contact Fifth Season Financial to understand if this option might be right for you.

Understanding your assets and expenses is often the first step to minimizing the financial toxicity of a cancer diagnosis.

Our guide, Navigating Finances After Cancer, will be available for FREE download here:

Triage Cancer will also be hosting a webinar on Finances & Thinking Outside the Box on January 20, 2016.  More information can be found at

Health Insurance & Open Enrollment: What You Need to Know

Man-on-a-PathWe know that health insurance can be overwhelming and stressful. But it doesn’t have to be. The Patient Protection and Affordable Care Act (ACA) includes changes to make it easier to shop for, and purchase, insurance.

As we approach the second open enrollment period (November 15, 2014, through February 15, 2015) to buy insurance coverage through the state Health Insurance Marketplaces created by the ACA, here are a few tips to help you navigate health insurance.

  1. Make sure you understand common health insurance terms. Don’t be embarrassed if you’ve heard these terms a lot, but still don’t totally understand them or how they all work together. Here are a few critical ones:
    • Premium: the amount you pay monthly just to have health insurance
    • Deductible: the amount you have to pay each year before the health insurance policy starts paying for your medical expenses
    • Co-Pay: an amount you may have to pay each time you access certain health care services (e.g., $25 when you see the doctor, or $10 for each prescription drug)
    • Cost-share: the difference between what your health insurance policy pays and what you pay for your medical expenses (e.g., 80/20 plans are ones where you are responsible for 20% of your health care costs and the plan is responsible for 80%, after you meet your deductible)
    • Out-of-Pocket Maximum: the most you are responsible for paying for covered medical care each year. The deductible plus any co-pays or cost-share amounts that you pay add up to help you reach out of pocket maximum. Once you reach that amount, your insurance should pay for 100% of your covered medical expenses.
  1. Keep an eye out for hidden costs as you shop for new insurance. For example, if you are in the midst of treatment, a Bronze level plan (60/40 cost share) is likely not going to be appropriate. And pay attention to whether or not plans have separate deductibles for medical services and prescription drugs.
  1. Learn about what is actually included in the ACA and how the law may potentially benefit you. One resource would be Triage Cancer’s Quick Guide to the ACA, available for free at:
  1. Look into possible financial assistance options available to you.
  1. Know that that there are places to go for more help when trying to navigate health insurance:


Triage Cancer Partner Highlight: Fifth Season Financial


A year after Adam and his family moved to the United States from Canada, his wife, Tracey, was diagnosed with breast cancer. While dealing with the sobering realities of their new situation, Adam began to experience first hand how very differently the U.S. health care system operates, as compared with a more comprehensive and inclusive Canadian system.  Adam quickly realized that there are ample ways to support patients medically and emotionally, but very limited structured support for the financial strains patients often face.

A 2010 study by the National Cancer Institute estimated that Americans will spend $158 billion annually on cancer treatment by the year 2020.  That figure represents a staggering annual 27% increase. 

Given Adam’s experience and statistics like these, Adam was motivated and inspired to proactively do something about it.  Adam passionately believes in the mission of Fifth Season Financial – a company that provides financial assistance for those facing advanced illnesses, including cancer.  He made it his mission to help people who are struggling with all of their financial pressures; rent or mortgage bills, utility bills, medication, or anything else that might be causing a financial strain.  To date, Fifth Season has assisted over 330 patients and their families – and provided over $55 million in financial help through the “Loans for Living” program.

Fifth Season aims to be a financial resource for those needing to gain access to immediate cash, which the “Loans for Living” program provides, by securing a loan through the patient’s life insurance policy.  Loans are usually between 30% – 60% of the face value of the life insurance policy.

However, a key goal of Fifth Season’s program is to provide patients with access to cash they need now, and to also preserve part of the policy for the patients’ family and dependents. There are only two requirements to qualify for the program – having advanced cancer and having a life insurance policy. The evaluation process is very simple and free of charge. There are no restrictions on how the money can be used, and it generally does not disqualify someone from government or other needs-based assistance programs.

This is what two of Fifth Season’s clients had to say:

“As a committed Christian, I don’t toss around the term Godsend lightly. But I can truly say that’s what Fifth Season has been for me. Just knowing the money is there to pay my living expenses and keep my new business going makes all the difference in the world. Stress is terribly counter-productive when you’re facing a life threatening disease like cancer – and like it or not, financial stress is one of the worst” – Lisa from Colorado

“Fifth Season gave me financial piece of mind, and allowed me to focus my energy on my condition, and my family’s well-being…thank you.” – Stephanie from Virginia

Adam Balinsky is the President of Fifth Season Financial, an organization that provides financial help to individuals diagnosed with advanced cancer. For more information about Fifth Season Financial, call 866.459.1271 or visit

Hot off the Presses!

COCHave you been on the search for a comprehensive resource on navigating your way through the cost of a cancer diagnosis?

Look no further!

Triage Cancer teamed up with our partner, Cancer Support Community, to bring you the Fifth Edition of Frankly Speaking About Cancer: Coping with the Cost of Care.

Finances are stressful enough, let alone when you have a cancer diagnosis. This FREE educational resource provides patients and their loved ones the most recent information when it comes to managing the cost of care. This edition includes topics such as:

  • The most up-to-date information on health care reform and health insurance options, including the Health Insurance Marketplaces
  • Updates on ways to help pay for treatment
  • Employment protections and disability insurance benefits
  • New information on cancer community resources
  • And so much more!

Share this resource with your health care team, advocacy groups, or anyone who might be battling the cost of cancer care.

Order or download Frankly Speaking About Cancer: Coping with the Cost of Care for FREE here:

Have questions and/or comments about the book? Email us at

Follow us on Twitter or on Facebook for additional resources on cancer survivorship!


Finding Help with the Cost of Medicine

Every day, more and more Americans are facing high medical costs. Uninsured Americans are facing the most difficulty, often looking at extremely high medical bills and expenses they must cover on their own. People with insurance are feeling the pinch as well with high deductibles and co-pays draining their bank accounts. For those struggling with the healthcare costs, there are many different kinds of programs and resources across the country designed to help. But they can be difficult to locate and are not well advertised. NeedyMeds can help you find these often life-saving programs.

NeedyMeds is a nationwide non-profit organization that maintains a website of free information on programs that help people who can’t afford medications and healthcare costs. We regularly update data on over 5,000 assistance programs, 13,000 free/low-cost/sliding scale clinics and 1,000 drug discount coupons. All our information is accessible online, at no charge and without registration.

One of our most popular resources is our Patient Assistance Program database.  Patient Assistance Programs provide medications for free or at low-cost to patients who qualify. Each program is different, but most are designed for uninsured or underinsured patients with low-income. To find a program on the NeedyMeds site click on the Brand Name Drugs list or Generic Name Drugs list to locate your medication and find out if there might be a program available. Click on the name of the medication to get information on the program, including application forms and contact information.

We list many programs that are diagnosis specific as well. In the Disease Information Page section you’ll find pages that contain all of the help available on one centralized page. They are a great place to start your search for help on the website, as they link to other sections of our website, as well as to additional outside resources. In addition to a general Cancer Resource Page, you can find resources for specific cancers including Breast Cancer, Leukemia, Lung Cancer, Melanoma, Lymphoma and Prostate Cancer.

We also provide a free drug discount card that offers a discount of up to 80% at more than 63,000 pharmacies nationwide. Anyone can use the card regardless of income level or insurance status and no registration is required. The card can be used to save on prescription drugs, over-the-counter drugs and medical supplies written on a prescription form.

For more information visit NeedyMeds website.


Triage Cancer Partner Highlight: NeedyMeds

Today we introduce you to NeedyMeds.  NeedyMeds is a Triage Cancer partner who is doing amazing work to help those who may need access to lower cost care and prescriptions. Please read on to learn more about their services! 

Needy Meds Logo

All About Free and Low Cost Clinics

One of the most popular sections of the NeedyMeds website is our listing of Free, Low-Cost, and Sliding-Scale clinics.  As health care has become more and more expensive, the need for low-cost health care has increased.  Many people living in more rural parts of the country have a very limited number of options to see a doctor, and depending on their insurance status the number of available “in-network” doctors is even lower.  Many people do not regularly see their doctor, only seeking help when a more serious condition arises.  It can be a scary situation to be uninsured and have an unforeseen medical problem come up.

 Free, Low-Cost, or Sliding Scale?

We list three different types of clinics on  The first are free clinics which are of no cost to the patient (self explanatory).  The second are low-cost clinics which usually have a low flat-fee for all patients or types of visit.  The third are sliding-scale clinics.  The price for these clinics is based on the patient’s ability to pay, and is usually derived from their income and family size as it relates to the federal poverty level(link to page explaining).

 What Services are Offered?

Each clinic offers a different variety of services.  Many clinics are just medical clinics and do not offer any other services, and there are also many strictly-dental clinics.  There are plenty of clinics, however, that offer a wide array of services.  Some services include women’s health, mental health, family planning, STD testing, vision, pediatrics, podiatry and pharmacy services among others.  Each clinic also has its own hours, and may only serve select towns or counties.

 Are There any Requirements?

Every clinic also has its own set of eligibility requirements.  In most cases these requirements deal with insurance status, income and family size.  Some clinics require that the patient has no insurance whatsoever while others work with both the uninsured and underinsured. Many clinics accept patients on Medicare and Medicaid – but not all.  Sliding-scale clinics in general have an income requirement based on the federal poverty level, making the clinic only available to those under a certain annual income.  There are also many clinics that have no income requirements.

 How do I Find a Clinic?

We list over 13,000 clinics on NeedyMeds, making it very easy to find one near you. From the Free Clinics page, either click on your state or type in your zip code to find a clinic in your area.  A list of local clinics will appear with contact information, as well as eligibility requirements, services, and hours. You can print out a selection of clinics or the entire page of clinics from your search.

Samuel Rulon-Miller has been with NeedyMeds since 2010, and manages their blog The NeedyMeds Voice. You can reach him at For more information on NeedyMeds visit

*This blog was originally posted on The NeedyMeds Voice on January 14, 2014.


A smarter way to get cash from your life insurance policy

A cancer diagnosis can often take a financial toll on the patient and their loved ones.  A 2009 study found that medical bills and illnesses are involved in over 62% of personal bankruptcies. Upon diagnosis, out-of-pocket costs immediately begin to accumulate.  Prescription medication, doctor’s fees and surgeries can be financially overwhelming, especially when the family’s primary provider is diagnosed.

When facing financial hardship patients will often cut back on other expenses, tap into savings, run up credit card debt and liquidate assets.  While it is often looked upon as an expense, your life insurance policy can actually be one of your largest sources of cash available today.

There are companies out there to assist you with reviewing your policy and figuring out what your options might be.  For example, Life Credit Company, is a company that offers the Living Benefit Loan™ program.

As a licensed consumer finance company, Life Credit Company has developed a new way to get cash from your life insurance policy.  A Living Benefit Loan™ enables you to borrow money against your life insurance policy without the personal obligation to repay.  Upon your passing, the loan is repaid using your policy’s death benefit proceeds, with the remainder going to your beneficiaries.  You will never be obligated to make loan payments or incur any out-of-pocket expenses.  You are not required to pay insurance premiums while you continue to keep ownership of your policy.  As a result of this program, you can get the money you need today, while preserving a portion of your life insurance policy for your beneficiaries.

If you have an immediate financial need that can only be solved with your life insurance policy, consider exploring these options before pursuing a Living Benefit Loan™:

  • Call your insurance company and ask them if your policy has any cash value.  You may be able to use some of the cash value to meet your immediate needs and keep your policy in-force for your beneficiaries.
  • Find out if your life insurance policy has an accelerated death benefit rider.  An accelerated death benefit is a benefit that allows you to receive a portion of your death benefit directly from your life insurance company if you have been diagnosed with a terminal illness.

If your policy doesn’t have a cash value and you don’t have an accelerated death benefit, a Living Benefit Loan™ might be exactly what you need to help with your financial demands.

For more information about the Living Benefit Loan program visit

Life Credit Company, LLC is a licensed consumer finance company providing life insurance policyholders with access to funds via a Living Benefit Loan™. Having facilitated over $250 million of loans, our team has the experience and resources to effectively assist you.

This blog is for informational purposes only. It is not intended to replace professional, legal, or medical opinions or advice.  It is not Triage Cancer’s intent for persons to rely upon information on this site in lieu of legal or professional advice.  We do not endorse any companies, treatments, brands or manufacturers of any materials used for the sale of products, policies, diagnosis, or treatment of any condition. Any opinions expressed within this site are the opinions of the writers and not those of Triage Cancer. Reliance upon anything written by any person associated with Triage Cancer and/or within this site is solely at your own risk.

Inching Closer to a National Standard for Paid Sick Days

By Helene Schonbrun

In June, when New York became the most populous city to require employers to offer  paid42-15530364 sick days, it not only gave one million workers access to sick pay that they did not have before, but it fueled hope for those working towards a national mandate.  Debra Ness, President of the National Partnership for Women and Families, called passage of the New York City law a “huge pivotal step for the country.”

The Proposed Healthy Families Act

In a 2009 study of twenty-two countries with comparable economies, the U.S. is only one of three that had no national policy requiring employers to offer paid sick days.  San Francisco was the first city to mandate sick pay, in 2007.  New York City has since joined Washington, DC, Seattle, WA, and Portland, OR in passing sick pay laws.  The only state that has passed legislation was Connecticut, in 2011.

The federal Healthy Families Act has been introduced several times over the last few years, but has failed to emerge from Congressional committees.  The bill was reintroduced in Congress in March, by Representative Rosa DeLauro of Connecticut and Senator Tom Harkin of Iowa and was sent to House and Senate Committees for review.  Surely, its sponsors are hopeful that it will benefit from the momentum generated by the recent victory in New York, where Mayor Bloomberg’s veto was overridden, as well as from the twenty other sick pay campaigns in cities and states across the country.

Purposes and Effects of the Bill

The Healthy Families Act will let thirty million more workers earn paid sick days, expanding access to ninety percent of the private sector workforce.

  • For the individual:  It spares employees from having to make the choice between taking care of themselves (or a family member) and losing a day’s pay or risk being fired. In a 2010 University of Chicago study, one in eight workers reported that they or a family member had lost a job, been threatened with job loss, or been penalized when they had taken time off to care for themselves or another relative.

  • For the public: Another purpose is to avoid a substantial health risk that occurs when employees come to work sick, especially those who serve the public. Forty percent of the U.S. private sector workforce and seventy percent of low-wage workers – including food service, hospitality, nursing home care and child care employees – lack sick pay. Also, the health risk of infecting other children at school or daycare is avoided when parents can keep a sick child home because their pay or job is not being jeopardized by their absence.
  • For business: Money for workplaces will be saved.  According to Representative DeLauro, “presenteeism,” that is, showing up to work when ill, costs $160 billion in lost productivity for businesses each year (more than absenteeism) and also causes more on work-site accidents.  In the long-run, healthier employees will boost productivity and improve worker retention.  Additionally, businesses will share in a huge savings in healthcare costs, reaping the benefits of 1.3 million fewer emergency visits each year, which will save $1 billion in health care costs for public and private payers of health insurance.

Earning and Using Sick Time

The Healthy Families Act requires that businesses with fifteen or more employees allow workers to earn up to seven days (fifty-six hours) of paid sick leave per year.   Workers will earn a minimum of one hour of paid sick time for every thirty hours worked and will be eligible to take paid sick time after working sixty days.

It allows use of sick days to:

  • Recover from an illness and care for a family member who is ill: An employee may take time off to care for herself or a family member such as a parent, parent-in-law, spouse, or child, as well as a domestic partner and her parent or child.
  • Go to a doctor or other appointment for preventive care or a diagnostic procedure: An employee may use her sick time to go to a routine check-up or other preventive care appointments, such as a mammogram screening.  This provision removes a barrier to receiving cancer screenings and preventive care that a 2012 study found exists for those workers who do not have paid sick days.
  • Seek help and services if one is a victim of domestic abuse: Domestic violence causes eight million days of lost work because victims need to take time off for health-related reasons and to otherwise deal with their situation, such as going to court for restraining orders and finding housing.

Opponents of Sick Pay Legislation – Preemption Bills

There is much to be overcome if sick pay is to become the national standard.  Business owners and those who protect their interests have opposed sick pay laws because of financial concerns that they say will render their businesses unprofitable and could cause them to have to make cuts in their workforces.  Some cities, such as Philadelphia, whose bill was vetoed by its Mayor, have been unsuccessful in overcoming these concerns, and efforts to pass sick pay laws in those cities have failed.  In addition, preemption bills barring cities and localities from enacting sick pay legislation have been passed in half a dozen states, most recently in Florida, and more preemption bills have been proposed.

Opposition abounds, despite the fact that sick pay has been shown to have an overall positive effect on the economy.  A recent article in The New York Times discusses the effects of the implementation of sick pay laws in those cities that mandate it and concludes that the great concerns of businesses have generally not materialized.

What You Can Do

Thirty million people need your help!  You can  contact your members of Congress and encourage them to support the bill.  Currently, it has 117 co-sponsors in the House and 19 co-sponsors in the Senate, the largest number of co-sponsors ever garnered by the bill.

Check whether your Representative and Senators are co-sponsors.  On these websites, you can also click on the House and Senate Committees, which are reviewing these bills, to get a list of the Committee members, to contact them, as well.

If you need help finding the names of your members of Congress, please visit Open Congress.

For more information on city-, county-, and state-wide sick pay campaigns around the country and to learn how to get more involved, visit

Helene Schonbrun is an attorney living in New York who recently externed at the LegalHealth unit of NYLAG (New York Lawyers Assistance Group).  She is also a cancer survivor and writer — her latest piece, a personal perspective on BRCA testing, was posted on the National Cancer Legal Services Network blog at