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Tackling the Financial Challenges of Kidney Disease

Being diagnosed with kidney disease not only brings with it a variety of emotions, but also financial obligations…many of which are difficult for patients to meet. Many typically face daunting financial challenges over the years as some patients are forced to give up their job due to this chronic illness. Bills can seem to increase from year to year as sources of income become smaller, and many patients are overwhelmed by the cost of health insurance premiums.

“It’s frustrating not having enough money for my own medicines, groceries and basic necessities. Always being dependent on others is hard,” said Pam, current home hemodialysis patient. This story of financial hardship is all too familiar to many people with kidney disease. Patients face high out-of-pocket costs, and the logistical and physical demands of dialysis treatment can make it difficult to work full-time; in fact, one recent study found that only 19 percent of dialysis patients ages 18 to 54 are employed.

Dialysis center social workers are on the front lines of this financial struggle. They see the challenges their patients face, and they work to connect their patients with sources of assistance. Pam’s social worker suggested submitting an application to the American Kidney Fund (AKF) for assistance in paying her health insurance premiums.

Founded in 1971 to help just one person pay for dialysis, today the AKF is a national non-profit organization helping tens of thousands of people every year. AKF’s mission is to fight kidney disease through direct financial support to patients in need; health education; and prevention efforts. AKF has several categories of patient assistance programs. Each program has strict eligibility requirements, allowing AKF to ensure its aid is going to those patients who have exhausted other means of support. It is important to note that AKF does not accept grant applications directly from patients; instead, the dialysis center social worker must apply on behalf of the patient. This is because social workers are required to verify details of patients’ income, savings and other financial criteria.

Health Insurance Premium Program (HIPP)
AKF’s Health Insurance Premium Program (HIPP) assists more than 50,000 dialysis patients in the United States. HIPP pays premiums for Medicare, Medigap, commercial and/or COBRA health coverage. Applicants must demonstrate that they can’t afford to pay the cost of health coverage; HIPP eligibility is restricted to patients who have no means of paying health insurance premiums and who would forego coverage without the benefit of HIPP. Alternative programs that pay for primary or secondary health coverage, and for which the patient is eligible, such as Medicaid or state renal programs, must be used first. To qualify for HIPP, a patient’s monthly household income may not exceed reasonable monthly expenses by more than $600, and a patient may have no more than $7,000 in savings, stocks and bonds.

HIPP is available for dialysis patients only, and it is important for patients to be aware that they are no longer eligible for HIPP assistance once they receive a transplant. Once a patient is accepted into HIPP, there is no annual maximum grant amount. HIPP is supported by voluntary contributions from dialysis providers.

Safety Net Program
AKF’s Safety Net Program assists both dialysis and transplant patients with small grants to help patients pay for necessities such as transportation to dialysis, medication co-pays, nutritional products and emergency assistance. A patient may receive a grant of up to $175, once every six months, from AKF, and eligibility for a Safety Net grant is limited to patients who have no more than $1,000 in savings, stocks and bonds. More than 32,000 patients received AKF Safety Net grants last year.

Donated Medication Program
The AKF administers Genzyme’s Renal Patient Assistance Programs. Assistance is made possible by a generous product donation from Genzyme. Through this partnership, two drugs commonly prescribed to dialysis patients– Renvela® and all formulations of Hectorol®– are available to financially qualified dialysis patients who have no prescription drug coverage. Eligible patients may receive up to a four-month supply, and if necessary, may reapply at the end of their grant period.

One application allows a patient to apply for Renvela® or Hectorol® Product. Applications are accepted on a rolling basis, throughout the year. To be eligible, a patient may have no more than $1,250 in savings, stocks and bonds. More than 2,000 financially qualified dialysis patients with no prescription drug coverage received assistance through this program last year.

Medicare Part D Program for Prescription Bone Medications
AKF offers a grant program that provides qualified dialysis patients help with the costs of their prescribed medications covered under Medicare Part D. AKF’s Medicare Part D Program for Prescription Bone Medications covers Fosrenol®, Hectorol®, Renagel®, Renvela®, Sensipar® and Zemplar®. Dialysis patients may receive grants to help with their deductibles, co-pays and coverage gap (donut hole) costs for prescribed bone care medications that are covered by Medicare Part D. (Part D premium assistance is not available). Eligible patients may apply to receive up to $2,000 per year.

Grants are provided in the form of a pharmacy benefit card that may be used at most pharmacies nationwide. It is important to note that as a charitable organization, AKF offers this Medicare Part D grant program contingent upon funding from outside grant sources. As of December 2010, registration for this program is closed to new patients; however, patients should check with their social workers periodically to find out if the program has reopened for applications.

Pediatric Summer Enrichment
The AKF offers grants of up to $200 to children who are on dialysis or who have had a kidney transplant. These grants help children with kidney disease attend camps of their choice. These programs offer all the fun of traditional camps, but they are also equipped with the facilities and personnel to handle the unique medical needs of these children.

Other Sources of Assistance
While the AKF is the nation’s largest charitable source of financial assistance to kidney patients, it is by no means the only source of assistance and information. One important resource, for example, is the Partnership for Prescription Assistance. The Partnership for Prescription Assistance helps qualifying patients without prescription drug coverage get the medicines they need, and many will get their medications free or nearly free. Patients may call 1-888-477-2669 to determine if they are eligible for prescription assistance from one of hundreds of available programs.

Patients who are looking for help navigating the complex world of treatment-related assistance are invited to call the AKF’s toll-free HelpLine at 866-300-2900. The HelpLine is staffed with health educators who speak both English and Spanish, and who can provide information to callers about the variety of assistance programs and organizations that may be of help. Alternatively, patients may send an email to helpline@kidneyfund.org and it will be answered by a member of the AKF HelpLine staff. It is also important to research local or state programs that may be available to patients with financial limitations. Discuss your financial situation with your social worker to learn about all the local or state options that you may qualify for. Although there are many financial challenges that come with being a kidney patient, there is no need to face those challenges alone.

LaVarne A. Burton is President and CEO of the American Kidney Fund, the nation’s leading source of charitable assistance to kidney patients. Visit www.kidneyfund org for more information.

This article originally appeared in the November 2011 issue of aakpRENALIFE magazine.