Treatment for any type of cancer can be financially overwhelming. Treating advanced cancer piles on the expenses at a time when your primary concern is comfort and recovery, whether it is your own or that of your loved one.
Here, we’ll give you some tips on managing treatment decisions for metastatic prostate cancer and what you can expect it to cost.
Once prostate cancer has metastasized, treatment focuses on slowing the cancer’s spread, controlling symptoms, and treating pain and discomfort associated with bone metastasis.
According to the
- androgen deprivation (hormone) therapy
- clinical trials using experimental treatments
- treatment for the pain of bone metastases
- bisphosphonates and denosumab to slow bone growth
- corticosteroids for bone pain
- pain medications
It’s estimated that
- $28,000 for early stage care
- $2,600 for continued care
- $74,000 for care in the last year of life
The cost of treating cancer varies a lot depending on:
- your or your loved one’s condition
- whether you or your loved one have insurance
- where you or your loved one gets treatment
When estimating total treatment costs, consider the following factors:
- office visits
- clinic visits
- lab tests
- drug costs
- hospital stays
- home health care
Your or your loved one’s healthcare team can provide more information about what costs you can expect. Here are some helpful questions that the
- What is the estimated total cost of the recommended treatment plan? Are there less costly options and how effective would they be?
- How much will my insurance cover, and how much will I pay out of pocket?
- Do I need preapproval from my insurance company?
- How far do I have to travel for treatment?
- How much will my prescriptions cost, and are generic prescriptions available or recommended?
- What financial assistance is available to me?
“Insurance coverage for treatment will vary depending on the type of insurance plan and treatment you are taking,” said Michele McCourt, executive director of CancerCare Co-Payment Assistance Foundation, an organization that helps people with cancer cover the cost of treatment.
Even with insurance, out-of-pocket costs can be significant. “With the rising costs of health insurance, most will face high premiums and high deductibles with copays and coinsurance costs for treatments,” McCourt said.
Most prescription insurance plans offer tiered coverage. Specialty pharmacy medications, like the oral chemotherapy medications used to treat metastatic prostate cancer fall in the highest cost tier, McCourt explained.
Because most prostate cancer patients — about 60 percent, according to McCourt — are diagnosed over age 65, they are often insured by Medicare. This means they may have a wide range of benefits depending on what plan they have.
CancerCare Co-Payment Assistance Foundation primarily works with people who have a Medicare Part D prescription drug plan and have been prescribed an oral chemotherapy medication.
One downside is that Medicare Part D leaves patients’ prescriptions uncovered in the middle of treatment. This gap in coverage is called the donut hole.
Imagine your insurance coverage is shaped like a donut. At the beginning of treatment, the insurance plan helps with your prescriptions up to a certain amount. Then you enter the donut hole, where you are responsible for the total cost of prescriptions. Once you spend your out-of-pocket cost maximum, you leave the donut hole and your insurance covers a percentage of drug costs again.
The high cost of specialty pharmacy medications means patients “will go into the coverage gap or donut hole with their first or second month supply of treatment,” McCourt said.
We also spoke with Ginny Dunn at HealthWell Foundation, an organization that helps people pay for the treatment of chronic health conditions. She explained that an out-of-pocket copay for their average patient grantee requires approximately $4,000 per year to meet their copay obligations for prostate cancer.
Although Dunn said cost shouldn’t be a factor in determining the best course of treatment and what medications to take to treat the cancer, it does often play a role in a person’s decisions.
According to Dunn, this may lead people to skip their treatment altogether or opt for a “suboptimal treatment regimen” that they feel they can afford. Dunn explains that HealthWell Foundation’s “mission is to make sure that patients don’t have to choose between their medication and paying for food or for rent or for anything else vital.”
You will need to consider several pieces of information when making treatment decisions, including:
- what stage your cancer is in
- your age and life expectancy
- other health conditions you have
- your doctor’s opinion about the urgency of treatment
- odds that treatment will help or cure you
- potential side effects of treatment
With major medical decisions, it’s a good idea to get a second opinion from another doctor.
When you’re deciding on a cancer treatment plan, the healthcare facility should be able to provide support for that decision.
“Many treatment facilities provide financial counselors, patient navigators, or social workers who will discuss treatment costs with the patients based on their specific insurance plans. They will also try to find financial assistance for patients through organizations such as ours,” McCourt said.
However, McCourt added that the demand for assistance is greater than the amount of available funding.
If the best treatment plan for your or a loved one’s prostate cancer is outside your budget, there are organizations like HealthWell and CancerCare to help.
“If a patient doesn’t have insurance, there are various free drug/safety net programs out there that could be of assistance,” Dunn said.
Patient advocacy organizations have resources within each different disease area, explained Dunn.
HealthWell Foundation and CancerCare Co-Payment Assistance Foundation are just two organizations that help people with prostate cancer manage their medical bills. Find more information here:
An advanced cancer diagnosis is not only emotionally draining, but healthcare costs can add up fast.
If you or a loved one has metastatic prostate cancer and are making treatment decisions, it’s important to gather information about expected expenses from your doctor and your insurance company.
The treatment facility may also be able to provide counseling and resources for organizations that will help cover medical expenses.