CTR Health & Wellness Insights

  • Understand the tradeoffs between monthly premiums and deductibles/copays – low monthly premiums (HMO or CDHP vs. PPO) usually have very high deductibles and copays in relative terms. You need to do the math to understand that low up-front costs might have high back end costs. Every plan is different so get out your calculator.

  • Dial in on your pharmacy plan – make sure each of your medications is covered, understand the most cost effective way to get your medications delivered – retail v mail order. Understand that major vendors (Target and Costco) are less expensive than the retail pharmacies.

  • See if your expensive medications offer a patient assistance program – many manufacturers offer discount programs to keep you buying their medications. Work the system to your favor.

  • Be sure your doctor and preferred hospitals are in-network for your plan – you need to present your actual plan numbers to be certain. Don’t accept the doctor’s office statement, “why, yes. Dr. Smith takes Anthem.” She may take some Anthem plans, but not all. You need to understand the network limitations of your plans – the providers don’t care until they bill you. Do not rely on general statements.

  • Think about your medical future as it applies to your medical benefits and plan ahead. You may need access to research centers in other parts of the country. You may need access to different physicians for second opinions. Find out now.

  • Check on the mental health benefits of your medical plan – no, serious medical illness doesn’t make you crazy. It can tax your mental health and the health of your family. Understand that there are mental health resources to use. So, use them.

  • Be sure that your family keeps up with their health and well-being. They need to carve out time to assure that they are “tan, fit, and Rested.”

Most cancer patients don’t really learn about their medical benefits until they are diagnosed with a life threatening illness like cancer. That’s “par for the course”: most of us don’t learn about our auto insurance coverage until we have an accident. Hopefully, you made good choices that provided needed coverage before you needed it.

These are some quick thoughts about insurance coverage in general:

These are the basics. Just like you are fighting back against your illness, you need to fight back and ensure you get the most possible from your medical benefits plan.

Insurance expert Mark Mathias of Mathias Benefits Group wrote this article. www.mathiasbenefitsgroup.com

by Amanda Haddock, President, and Co-Founder of Dragon Master Foundation

Virtually all advances in the care of cancer patients have occurred as a result of clinical research.

Before my son, David was diagnosed with brain cancer, I thought that clinical trials were scary experiments that were a little better than science experiments. I remember when it was suggested that we look into clinical trials for David. I remember the “no” screaming in my head, but I had already heard scarier words: Malignant. Glioblastoma Multiforme. Terminal.

At that time, there was no hope for David using traditional medicine. Our doctors were pretty frank that the clinical trials didn’t hold much promise either. It wasn't easy to know what to do. Should we take a chance on a traditional treatment that statistically didn’t show much chance of helping David? Or should we choose a clinical trial that was mostly unknown? That old quote came to me at some point: “Insanity Is Doing the Same Thing Over and Over Again and Expecting Different Results.”

It felt like we were not going to get anywhere with the treatment that had been failing people for decades. When we looked at it like that, the clinical trial seemed like the only option. As we explored the clinical trial details at a deeper level, we started to understand the process better, and it became a lot less scary.

Clinical trials make sense for patients who don’t have a treatment plan that will give them their desired outcome. People approach cancer and its treatments very differently, and it is important to take that into account when considering trials. Still, if the traditional treatment plan seems unacceptable, then a clinical trial may be what you seek.

In case you may one day find yourself having to navigate a similar situation, here are some details you need to know.

HOW CAN YOU FIND CLINICAL TRIALS?

At most major cancer centers, the oncologists will have some available suggestions for clinical trials. However, you may want to do your own research to make sure nothing goes overlooked. An excellent website to do clinical trial research is clinicaltrials.gov. It will let you search for clinical trials throughout the world based on your exact diagnosis.

I’m always hesitant to recommend talking to other patients because I think many biases are represented in the patient population. That being said, you may get much more detailed information from fellow patients than you would from the clinical trial doctor because of confidentiality issues. Just remember that each person is unique, and your experience may not match theirs.

WHAT QUESTIONS SHOULD YOU ASK?

Depending on what phase the trial is in, you may have access to a little or a lot of information, but here are some questions you can ask to decide if this is a process you are willing to consider:

  1. What phase is the clinical trial in? (More on that here.)

  2. What is the expected outcome of this phase of the trial?

  3. What are the known side effects of the treatment, and how likely are they to occur in each patient? How do those side effects compare to the “standard” treatment?

  4. How far would you need to travel to participate in the trial? How often would you need to go there, and how long would you need to stay?

  5. What kind of tests will be done to monitor your progress on the trial?

  6. How is the data from the clinical trial being shared? Will you be able to get a report on the results? And how quickly will that information be shared?

  7. What assistance is available for clinical trial participants?

  8. Will going on this trial limit the other treatment options that are available to you after the trial?

  9. Will the researchers work directly with your current oncologist? Who will be responsible for your care while on the trial?

  10. How long will the trial continue? Can you stay on the trial treatment as long as you respond positively?

  11. Under what circumstances would you be kicked off the trial?

This is obviously not an inclusive list, but hopefully, it will help you identify what issues are important to you.

HOW CAN YOU AFFORD A CLINICAL TRIAL?

This will vary, but several funding sources exist for legitimate clinical trials.

Funding from foundations to the clinical trial list can cover anything from the treatment to travel. This type of funding is managed by the clinical trial.

Funding from a drug company – These funds can also cover anything from the treatment itself to travel. This type of funding is managed by the clinical trial.

Funding from your insurance company – While many insurance companies won’t pay for a clinical trial, they usually will cover “standard” tests needed as part of your care. Things like blood tests and MRIs might be covered by your insurance company.

Funding from foundations directly to patients – Foundations may have funds available to help patients travel to and from treatments. It is worth exploring both national foundations and local foundations to see what they can offer.

Independent fundraising sites like GoFundMe. These sites are definitely more work but can provide funding for all sorts of expenses from clinical trials to help with your monthly bills.

These questions and suggestions only scratch the surface of the complicated world cancer patients must navigate. We will make it an ongoing priority to help share information that will make the path smoother for all.

This article was written by Amanda Haddock, President and Co-Founder of the Dragon Master Foundation.