Managing the cost of treating coronary artery disease

How can I get help paying for hospital-based care?

Coronary artery disease (CAD) and heart failure can both be very expensive medical conditions to treat. Fortunately, both large and small foundations have developed over the years to help people pay for care they otherwise could not afford. These foundations are located throughout the country and may be organized through religious groups, local companies, or individuals and their families.

What kind of charity care do hospitals provide?

Most hospitals operating in the United States are not-for-profit institutions whose mission is to provide high-quality health care to the communities that they serve. In many instances, this goal includes delivering medical services to individuals who cannot pay for care. In fact, as part of their federal and state not-for-profit status, hospitals are expected to allocate a certain portion of their overall revenues to community benefits, specifically in the form of free care to poor and underserved populations.

Many hospitals have set up their own foundations, whose sole purpose is to direct resources and support back to community health efforts. In addition to establishing free clinics in inner cities, initiating screening programs for breast cancer, and starting in-school nutrition programs, foundations also pay for the care of people who could not otherwise afford it. Since foundations are usually governed by strict rules delineating how much of their endowment they must distribute every year, they provide a less controversial way for hospitals to provide free or reduced-cost medical services.

If you have questions as to whether the hospital you visit has a foundation or official charity care policy, ask your doctor. Though your doctor may not be able to answer every question, he or she can direct you to an individual at the hospital who can.

How can I get help paying for prescription drugs?

As with hospital care, assistance is available for people who cannot afford the drug therapy prescribed for their condition. In the case of medications, it is usually the drug manufacturers that develop programs to distribute drugs free of charge to individuals who otherwise could not afford them. These efforts, called Patient Assistance Programs (PAPs), have been developed by most large drug companies and exist for hundreds of drugs.

Am I eligible?

As you might imagine, guidelines exist to help determine whether you are eligible to participate in PAPs. To receive drugs free of cost, pharmaceutical companies typically require that either:

• You have no outside source of health insurance.
• Any coverage you have is completely exhausted or deemed insufficient to cover the costs of medical therapy for your condition.

In the past, companies simply asked doctors to identify people most in need of drugs; once doctors filled out a small amount of paperwork, the appropriate medications were sent to them for disbursement to individual patients. However, as requests for participation in PAPs have increased, companies have increasingly turned to an application process so that they can best direct their efforts to those who are most in need. Although each company has established specific rules, most require that you and your doctor submit an application for free drug benefits, including information on your condition, income level, and the type of medication you need.

Author:	Robin Parks, MS	Last Updated May 26, 2006
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Linda F. Hellstedt, MSN, RN - Cardiac Nursing Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition
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