Strategies to avoid or delay the financial toxicity of self-paid medication
AI-translated from the Chinese original · editorially reviewed
A patient may choose self-paid medication as part of their treatment plan, but high-priced drugs without NHI coverage take an enormous toll on the family:
. Reduced income:
When a family member falls ill, someone in the household must rearrange their work schedule to provide care, cutting into family income. If the patient is the family's main breadwinner, illness-related fatigue or medical appointments will affect their work, and income suffers even more.
. Reduced disposable household income:
With income down and treatment drugs to pay for, the household has relatively less to spend on daily living, and quality of life declines accordingly.
. Shrinking savings:
Whether covering initial treatment costs or long-term self-paid medication, savings will inevitably be drawn down.
. Shrinking assets:
Families of patients often say things like, "We've already sold a house to pay for treatment." The longer the illness and drug purchases go on, the faster assets erode.
As the financial toxicity of treatment and drug costs grows, patients may:
1. Cut spending on medication: deviating from the prescribed dosage, reducing doses on their own, or not taking medication on schedule.
2. Start borrowing: turning to non-financial institutions and private channels to raise money for the household or for drug purchases.
3. Cut household expenses across the board: squeezing essential spending on food, clothing, housing, and transport to free up money for medication — with almost nothing left for recreation.
4. Develop anxiety, low mood, and other psychological distress under heavy financial pressure.
To avoid or delay financial toxicity — so the patient can obtain medication and complete the treatment plan while balancing financial and treatment risk — patients can take the following steps:
1. Discuss treatment options thoroughly with the physician: the differences between self-paid and NHI-covered treatment, the duration of treatment (medication), and the cash flow required.
2. Review the patient's medical insurance: estimate the payout the patient's medical insurance policies will provide. Most current medical policies pay out only for hospitalization, with a minority covering outpatient care. Whether coverage is reimbursement-based, daily hospital allowance, or lump-sum depends on the policy contract.
3. Review household income and expenses: for most families, income and spending during treatment (drug purchases) will differ from before. Face the gap honestly and estimate it carefully.
4. Review assets and liabilities: assess carefully which assets can generate income, which can be liquidated quickly, and which should be sold to repay debt or held as cash reserves.
5. Is support from relatives and friends available? There are always loyal and well-off relatives and friends willing to help in times of need — often a vital resource in helping a patient complete treatment.
6. Can government or foundation subsidies be applied for? Social assistance and social work services are another channel for obtaining money (or medication).
7. Does the drugmaker offer drug donation (a patient support or financial assistance program) or clinical trials? A manufacturer's drug donation program can give patients some financial breathing room during the purchase period, and lets spending decisions follow treatment response.
In addition, making good use of the right financial tools (such as bank loans or drug purchase installments) to improve affordability can also help patients complete treatment. Weighing both emotion and reality, the choice between pursuing (or continuing) self-paid treatment and switching to a less financially burdensome option remains a painful but necessary decision for the patient's family.
Join PatientsForce "Drug Installment" as a member (or add the official LINE account: @pappay) to request a household finance and drug cost estimation worksheet from our service staff, and run your own financial cash-risk assessment.
David Chen, Project Manager, Drug Installment, CareCompanion Life