The catalyst for this post was a recent trip to my local CVS to pick up medication. Because the drive-thru line was way too long, I decided to go inside the store. While waiting, I overheard two interactions centered around the cost of medication. In the first, the customer did not understand why his medication was not covered by either of the two insurance policies that he had. The pharmacy tech repeatedly tried to communicate that the primary policy did not cover it, and the secondary policy deferred to the primary policy. It absolutely could’ve been an instance where the insurance wasn’t properly processed, however, as it stood, the customer was facing the challenging decision of whether to pay over $1,000 for his medication. In the second, a customer who was looking to have a vaccine administered politely declined when she was notified that it would cost her over $200.
Both of these interactions illustrate the concept of financial toxicity. Desai & Gyawali define financial toxicity as “the detrimental effects of the excess financial strain caused by the diagnosis of cancer on the well-being of patients, their families, and society”3, though it certainly extends beyond cancer. A quick PubMed search will uncover numerous articles that highlight the issue of financial toxicity in other disease states. Wang et al. point out that “among all families with a member with heart failure (HF), during 2014 to 2018, 1 in 7 experienced high financial burden. This effect was more severe among low-income families, where 1 in 4 experienced high financial burden2.” According to Khera et al., “for families with a member with ASCVD, nearly 16% of the household income is spent on out-of-pocket healthcare expenditures. Moreover, nearly 1 in 8 (14%) or 2.7 million US families with a member with ASCVD reported financial hardship (out-of-pocket healthcare expense exceeding 20% of post-subsistence income) and 5% or 1 million families reported catastrophic health expenditures (out-of-pocket healthcare expense exceeding 40% of post-subsistence income)”1. There are many more similar or even more alarming statistics that reinforce the extent and prevalence of financial toxicity.
As evidenced by the KFF analysis above, financial toxicity has a fundamental impact on patients, but it is also a major hurdle for the healthcare industry as a whole. The entire life sciences industry operates under consistently tight deadlines, so it makes sense that the shorter path less focused on the financial burdens of patients is often taken in the name of speed and efficiency. Unfortunately, though the shorter path may be faster, it may also lead to the wrong destination and/or a much bumpier ride. Until and unless this is addressed, the industry will face challenges in having meaningful discourse regarding innovation and a cloud may persist over any progress that is achieved.
Desai & Gyawali suggest that the first step in addressing this issue is gaining a better understanding of the problem3. This is the call to action; as an industry, we should strive towards a deeper and more comprehensive understanding of the impact of financial toxicity on patients. We have never had access to as many resources as we have today that can aid in gaining a more complete picture of these topics and issues. If we take advantage of these resources to gain insights into the complex issue of financial toxicity, it can help to move the industry forward. There is no question addressing issues like financial toxicity will not be simple, but a collective effort to have a better understanding of relevant perspectives will allow the industry to be better equipped to overcome these and other challenges.
References:
1. Khera, R., Valero-Elizondo, J., Nasir, K. (2020). Financial Toxicity in Atherosclerotic Cardiovascular Disease in the United States: Current State and Future Directions. Journal of the American Heart Association, 9, e017793. https://doi.org/10.1161/JAHA.120.017793
2. Wang, S. Y., et.al. (2021). Out-of-Pocket Annual Health Expenditures and Financial Toxicity From Healthcare Costs in Patients With Heart Failure in the United States. Journal of the American Heart Association, 10, e022164. https://doi.org/10.1161/JAHA.121.022164
3. Desai, A., & Gyawali, B. (2020). Financial toxicity of cancer treatment: Moving the discussion from acknowledgement of the problem to identifying solutions. EClinicalMedicine, 20, 100269. https://doi.org/10.1016/j.eclinm.2020.100269
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