Cancer survival should not depend on financial survival

June is National Cancer Survivors Month. It is meant to recognize the growing number of people who have made it through diagnosis, treatment and the long road that follows.

But for many, surviving cancer does not mean life returns to normal. It often means carrying the financial consequences of care long after treatment ends.

Throughout my career, I have worked with oncology providers and patients across Florida and have seen how quickly costs can build. Cancer treatment is rarely straightforward. It can involve months, years or even a lifetime of care, including multiple therapies, specialists and follow-up visits. Even with insurance, patients are left with significant out-of-pocket costs, from infusion visits and imaging scans to medications that are not fully covered.

For some, the challenge begins shortly after treatment starts. Bills arrive in waves. Coverage gaps become more apparent. Patients and families are forced to make difficult decisions about what they can afford and when, sometimes delaying care simply to stay financially afloat.

Insurance is meant to provide protection in these moments, but too often patients still encounter high deductibles, prior authorization delays and coverage restrictions that make an already difficult situation even harder to navigate.

There has been growing attention in Washington on the drivers of medical debt, and that focus is needed. But meaningful solutions require a closer look at how different parts of the healthcare system operate in practice.

A recent report from the National Consumer League highlights one area that deserves more scrutiny. It found that cancer hospitals participating in the federal 340B Drug Pricing Program are more likely than non-340 B hospitals to pursue aggressive debt-collection practices, including legal action against patients. That finding raises important questions.

A separate analysis released by the North Carolina State Treasurer’s office raised similar concerns while examining outpatient oncology infusion drugs. The report found that 340B hospitals billed the state health plan more than five times their discounted acquisition costs, with higher markups than hospitals outside the program. While the report focused on North Carolina, the concern is broader: When discounts are created in the name of patient access, patients deserve to know whether those savings are actually helping lower the cost of care.

The 340B program was designed to help hospitals stretch resources and care for vulnerable patients. When hospitals can purchase medicines at a discount, the expectation is that those savings will improve access and affordability. But without clear transparency, patients and policymakers are left to ask whether the benefit is reaching the people the program was intended to help.

When patients receiving care are also facing lawsuits or aggressive collection efforts, it creates a disconnect that cannot be ignored. It suggests that the financial relief built into the program is not always reaching the people it was intended to help.

Programs like 340B should be aligned with clear expectations around how savings are used and how patients are protected from harmful financial practices. That includes improving transparency so it is easier to understand how program benefits are applied and strengthening oversight to ensure those benefits are reaching patients as intended.

At the same time, addressing medical debt requires looking at the full picture. That includes reforms to insurance practices that leave patients exposed to high out-of-pocket costs or delays in accessing care, even when they are already covered.

Policymakers should also take a closer look at medical debt collection practices, particularly those involving legal action against patients undergoing serious treatment. Clear guardrails can help ensure that efforts to recover costs do not come at the expense of patient well-being.

Cancer survivorship is a milestone worth recognizing. But for too many people, it comes with a second challenge that can last far longer than treatment itself. If we are serious about addressing medical debt, we need to make sure the systems designed to support patients are doing exactly that.

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Michelle Flowers is the Founder of Oncology Managers of Florida.