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Building Sustainable Health Care Access Through A Pay What Patients Can Afford Programme

Axios’s Patient Support Programs takes into account other factors beyond formal income, such as assets and standards of living, to determine a patient’s ability to pay for medical treatment.

Roshel Jayasundera, managing partner of Axios International.

KUALA LUMPUR, March 22 – Thirty-one-year-old Take (pseudonym) enjoyed an active and healthy lifestyle that included playing sports, rock climbing, and swimming.

She took good care of her health, consuming a diet replete with fresh fruits and vegetables, but in July 2016, she started coughing and developed a fever. A chest X-ray showed a large cancerous mass on her left lung.

The shock she felt upon receiving her medical diagnosis was compounded by anxiety over the cost of treatment, which was beyond her means.

Take decided to seek care in a government hospital, and that’s where she learned about the Axios programme, which helped reduce her treatment costs.

“The programme, for me, is one of the most significant reasons that I am still here today and thriving,” said Take.

“It could help spark hope for people who cannot afford their hospital bills. I am truly grateful that I was given a chance to be part of this programme.”

“Take’s situation echoes across many Asian countries and beyond,” Roshel Jayasundera, managing partner of Axios International, told Ova in an email interview.

People like her are facing the dilemma of forgoing their health as they are priced out of the treatment options currently available.”

She said Axios programmes help patients afford treatment and support them in addressing barriers they may encounter.

“In Asia, we have impacted and reached more than 100,000 patients in specialised disease areas such as cancer, HIV, and rare diseases in over 20 countries, including Malaysia, Singapore, Thailand, Cambodia, the Philippines, and Vietnam,” said Roshel, adding that the organisation is expanding its reach across the region.

“Axios International’s Patient Support Programs (PSPs) are designed to support patients across emerging markets to access innovative treatment in a sustainable manner.”

She noted that in many countries, patients do not have the resources to pay for long, expensive treatment plans needed to treat their conditions.

“In all we do, we focus on supporting patients’ ability to afford and stay on treatment so that they can maximise treatment outcomes,” she added.

Patient Financial Eligibility Tool

Axios has developed a proprietary scientific tool, called the Patient Financial Eligibility Tool (PFET) that helps assess how much a patient can contribute to their own treatment.

“This is done via a thorough assessment based on an individual’s income, assets, and standard of living,” said Roshel.

The patient is subsequently enrolled into a Patient Assistance Program (PAP) to receive financial support to undergo treatment.

The amount of support received will be determined based on the patient’s ability to pay after taking into account their household financial situation.

“Once we know their ability to pay, our programmes, which are based on cost-sharing models, help split the total cost of treatment between patients and other stakeholders, which makes the treatment affordable for patients,” Roshel explained.

The program is also designed to ensure that patients complete their treatment, which is achieved by mapping out their journey and identifying mechanisms to minimise any barriers.

Barriers To Treatment Completion

“There are various hindrances for a patient to complete treatment. For example, during the ongoing pandemic, many patients could not meet their physicians face-to-face, and in the absence of regular follow-ups, these patients went off their treatment schedules, impacting their health outcomes severely,” Roshel said.

“A large proportion of the patient’s journey occurs once they have left the doctor’s office, which is why Axios is driven to understand and serve the space outside the hospital by supporting patients holistically via our digital ecosystem (Axios+), which helps connect patients and all the stakeholders surrounding the patient,” she added.

According to a press release in 2020 announcing the launch of the digital tool, Axios+ digital solutions consist of MyHealth app for patients, MyPatients app for physicians, and MyPharmacy app for pharmacists, which are all linked to Axios’s digital Patient Management System.

“Axios+ has greatly eased the burden of submitting documents as well as validating the Medication Release Letter (MRL),” said Roshel, adding that a pharmacist from Subang Jaya Medical Centre has said that with Axios+, she is able to validate MRLs without burdening the patient and is also able to speed up the process.

“The MyPharmacy app has eliminated the hassle of the patient forgetting to send back the MRLs and has also sped up free-of-charge delivery which helps the patient stay on track on their medical journey.”

Axios works with governments, pharmaceutical companies, NGOs, and charitable organisations to deliver its programmes to patients.

In Malaysia, hospitals and health care providers inform patients about the Patient Support Program (PSP), according to Roshel, adding that Axios has also worked with non-governmental organisations and society groups like WeCare Journey, which is dedicated to the treatment of spinal muscular atrophy, and the National Cancer Society of Malaysia to refer patients to their programmes. 

Lack Of Awareness And Stigma

For women in Malaysia, lack of awareness is one of the key challenges and barriers to accessing health care.

“A recent study showed that the first and most essential step is to raise awareness about health issues affecting girls and women. Once they are more aware, we need to motivate them to take a proactive approach toward their own health and wellbeing,” said Roshel.

However, she added that once the decision to undergo treatment and treatment affordability are addressed, other barriers may emerge that hinder the effective execution of treatment plans.

“These may include an incorrect perception or stigma associated with a certain disease. Patients are less keen to stay on their treatment as they feel that their disease makes them an outsider in society,” she added.

Case Study: Young Woman With Plaque Psoriasis

Roshel related the case of a young woman in her early 20s from a lower-income group who was living with her parents and a sibling. The woman has been suffering from plaque psoriasis for the past five years.

Due to financial constraints, she was not able to get the biologics treatment that she needed.

The patient also suffered from low self-esteem as she has an active flare on her body. She stopped attending classes as she was afraid that people would judge her for her skin condition, and this, in turn, affected her studies.

“When the patient consulted a doctor, the doctor introduced her to a medicine to treat plaque psoriasis and informed her about our PAP,” said Roshel.

“PAP helped the patient comply with treatment without affecting her family’s financial situation. The patient got the benefits of the medicine and gained her self-confidence back.

“The young woman is back to college as usual and not afraid to go out anymore. Her mother said if the patient completed her studies, it would change their financial situation too,” said Roshel.

Those who earn a living in informal economies may find it difficult to ascertain their ability to pay for the treatment they need, according to Roshel.

However through Axios’s PFET, they can get a better picture of their ability to afford treatment as it considers other factors beyond formal income, including assets and standards of living to gauge financial ability and income.

“PFET helps us build customised treatment plans that allow patients to plan for their treatment based on their individual circumstances. This ensures that patients can pursue their treatment plan fully rather than just completing a few cycles of the treatment plan,” Roshel explained.

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