Skip to content

CancerCare AFP Survey for HCPs

As a healthcare provider (HCP), you and your patients may encounter an alternative funding program (AFP), an access barrier to specialty medications. If you receive requests from an external entity that differs from typical prior authorization requirements, and/or your patients share with you access challenges like those described below, their health plan may be using an AFP. We're seeking stories from both HCPs and patients to help our advocacy efforts to stop AFPs from interfering with access to medication/treatment and the harm AFPs cause to patients.

We encourage you to complete this survey, as well as share the link to the patient survey below with any patients experiencing access challenges to their specialty medications.

Link to Patient Survey: https://www.surveymonkey.com/r/HC529KG
1.Name/Preferred Name(Required.)
2.Email Address(Required.)
3.Phone (Optional)
4.Disease/Illness Type Treated (Examples: Cancer, Diabetes, Hemophilia, Arthritis, Lupus, etc...) Please include all that apply.(Required.)
5.Does your patient get their health insurance from their employer?(Required.)
6.Has your patient's employer health plan ever denied or delayed coverage for prescribed medication/treatment until they provided additional personal information, items such as tax returns, pay stubs, limited power of attorney, number of people in household, etc.(Required.)
7.Have you as an HCP ever been contacted by an external entity (other than your patient’s health plan) claiming to be working on your patient's behalf that required you to sign a form completed by the external entity (outside of the normal prior authorization process) so your patient could access their medication/treatment?”(Required.)
8.Have you as an HCP ever been asked to complete or sign a form provided by an external entity that you believe may misrepresent the coverage status of your patient's medication?(Required.)
9.Have you ever been told that your patient would have to pay out of pocket for the full cost of the medication if you, as their HCP, did not provide the information requested?
(Required.)
10.Have you as an HCP ever been told by a patient that their health plan imported their medication from another country?(Required.)
If you checked "yes" for two or more of the above boxes, your patient may be confronting an AFP which interferes with their ability to get their medication/treatment.
CancerCare is working to stop AFPs from interfering with patients' access to medication/treatment and the harm AFPs cause to patients.
11.We need your help to stop AFPs! If any of the situations described above sound familiar to you, we would appreciate you sharing your AFP experience. Please include any barriers, delays, and challenges you, as an HCP, and/or your patient, faced while navigating an AFP (whether or not your patient ultimately received their medication/treatment through their health plan). Real life HCP and patient stories are needed to help us stop AFPs.
12.May we use your story in our advocacy efforts to stop AFPs?
13.If yes, may we use ONLY your first name when we share you story?
14.Thank you for sharing your story!

Would you also be comfortable with CancerCare contacting you in the future to further discuss additional ways to help us advocate against AFPs?

If yes, we will contact you via email.