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Asembia AXS25: Patients Desire Education and Thorough Resources to Better Navigate Health Plans
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Key Takeaways
- Survey data showed low awareness of financial assistance programs and healthcare plan literacy among patients with chronic conditions.
- Only 1 in 5 adults are familiar with financial assistance programs, and 2 in 5 understand their healthcare plans well.
A panel of health care experts at Asembia’s AXS25 Summit discussed the critical need for improved patient education and resources to help navigate complex financial assistance programs and health care plans.
Adults and patients with chronic conditions across health systems have poor literacy regarding their health care plans and extremely low awareness regarding the range of financial assistance programs available to them, according to a panel discussion titled “The Cost of Care for Patients: Navigating the Financial Assistance Landscape,” presented at Asembia’s AXS25 Summit in Las Vegas, Nevada, taking place April 27 through May 1.
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“Clearly, education is needed,” Amy Niles, chief mission officer of the PAN Foundation, said during the discussion. “Educating patients and educating health care providers to raise awareness about financial assistance programs and to start providing simple, clear information to help people understand their health care plans.”
The panel featured Niles; Sheila Arquette, president and CEO, National Association of Specialty Pharmacy; and Elizabeth Johnson, board member and past president, National Association of Medication Access and Patient Advocacy. Each panelist sought to address the challenges of navigating health care plans from the perspective of patients, providers, and health care personnel.
Patients Lack Education and Literacy in Their Health Plans
Niles began the presentation by showcasing exclusive data collected by a PAN Foundation survey regarding the awareness of financial assistance programs and literacy regarding health care plans. Survey respondents included 2046 US adults, featuring 1273 who self-reported being diagnosed with a chronic health condition by a health care provider. The results were striking and showed that across the board, there is a very low awareness about a range of financial assistance programs.
Only 1 in 5 US adults and patients with a chronic condition report being extremely or very familiar with financial assistance programs, while only about 2 in 5 reported understanding their health care plan very well. Furthermore, most respondents replied that a range of resources would clarify and help them navigate their health plans and financial assistance programs.
Even more troubling is that about 3 in 10 respondents said they needed financial assistance with out-of-pocket costs, but of those respondents, 4 in 10 did not end up receiving such assistance. Niles highlighted the particularly notable result indicating that only 1 in 10 respondents sought out their pharmacist to receive information about financial assistance.
“I think it is a shame, because we know that pharmacists are trusted resources for so many individuals,” Niles explained.
As a former pharmacy director for a health plan, Arquette expressed her lack of surprise at the results, saying it was “overwhelming with respect to specialty pharmacy.” Patients, often overwhelmed and forced into confusing and complex financial situations, are simply trying to navigate their new circumstances.
“I think specialty pharmacies sit in a really great place, because they’re able to understand that a patient has an issue based on their interactions with the patient, health care team, and prescriber,” Arquette said. “If the patient can’t afford medications, it doesn’t matter how good they are.”
Johnson, contrastingly, was indeed surprised, though it was because the results indicated even less confusion than she expected. Johnson explained that solutions to the problem could be initiated at the physician-practice level, encouraging patients to ask all patients they may have.
“From a clinician practice standpoint, education of staff is really important,” Johnson said, expressing her belief that financial literacy should be taught in settings such as nursing, medical, and pharmacy school.
More Access to Resources
Johnson explained how ease of access to resources can allow patients to easily locate information for their health plan coverage without being bogged down in a whirlwind of sources or having to take time out of the day of pharmacists to answer simple questions. Correspondingly, Arquette sympathized with patients who may not want to have a sensitive conversation in a crowded pharmacy about affordability and their financial situations.
“It is about being able to project in a very compassionate way that we want to help you get better; just help us help you,” Arquette described.
Niles turned the conversation to reactions towards the statistic that patients are broadly not reaching out to pharmacists. Arquette said this was an expected result, given the changed landscape of community pharmacy. Pharmacists and staff in retail pharmacy are now too busy to assist these patients, and patients are becoming reluctant to have such discussions. Differently, specialty pharmacy has time built into their workflow to have difficult conversations regarding affordability.
“You risk that patient walking away from the pharmacy counter without having filled their prescription,” Niles explained.
Johnson expressed her view that these financial conversations should extend to discuss factors outside of the medication itself. This could mean discussing with a patient if they need assistance with transportation, groceries, and gas.
As far as resources go, Arquette said that patients desire a central database that includes easy-to-find links to any relevant information for patients. At her foundation, Arquette said that specialty conditions have their own dedicated websites so patients who are diagnosed can go right to them and access the information they need. Johnson said that, ideally, the onus would be on payers to explain in basic terms to patients what their plan entails, even providing definitions of what individual terms in their plan mean.
“The reality is, health care is a business. We can all agree on that,” Johnson said. “I think that providers and pharmacists need to understand the business side of health care too. They are clinically minded, and they are as smart as can be.”
