Closing the Gap Between Treatment Cost and What Patients Can Pay

Why One Approach to Affordability Doesn’t Work

The number of people living with chronic and serious diseases continues to rise worldwide. At the same time, advances in science and technology are making more innovative treatments available to patients.

But making a treatment available does not necessarily mean a patient can access it, or remain on it.

For patients living with cancer, diabetes, rare diseases, and other chronic conditions, the cost of treatment can be only one part of a much larger financial burden. Medication may compete with hospital visits, routine checkups, laboratory tests, transportation, and everyday living expenses. As the number of people requiring long-term care continues to grow, these pressures are placing increasing strain on patients and healthcare systems alike.

Cancer illustrates the challenge. As the number of people diagnosed with cancer continues to rise globally, so too does the demand for often complex and costly treatment. Better screening, earlier diagnosis, and new therapies are creating more opportunities to treat disease, but those opportunities can only improve outcomes if patients are able to start treatment and stay on it.

When patients cannot manage the financial demands of care, the consequences often appear as Cost-Related Non-Adherence (CRN). Patients may delay starting treatment, postpone refills, stretch medication further than intended, or discontinue care altogether. These decisions can worsen outcomes for patients while increasing pressure on healthcare providers and already strained health systems.

But affordability is rarely as simple as whether a patient can or cannot pay.

Two patients prescribed the same treatment may face entirely different barriers. One may have insurance but struggle to cover a monthly co-pay. Another may be waiting months for reimbursement and lack the cash needed to begin treatment in the meantime. A third may be able to contribute toward the cost of treatment, but not enough to cover the full course.

The amount a patient can pay is only one part of the equation. Timing, insurance coverage, reimbursement processes, household expenses, and the duration of treatment can all affect whether a patient is able to start, and continue, the care they need.

That is why addressing affordability requires more than simply reducing the cost of treatment. It requires understanding why treatment is unaffordable for a particular patient, and having more than one way to respond.

Closing the Gap with Tailored Financial Support

Before deciding what kind of support a patient needs, it is important to understand what they can realistically contribute toward their treatment.

Axios’ Patient Financial Evaluation Tool (PFET) was designed to help answer that question using an evidence-based approach rather than assumptions about what a patient can afford.

PFET assesses a patient’s financial circumstances to help determine their ability to contribute toward treatment. The assessment can then support decisions about the type and level of financial assistance that may be appropriate.

As of the time of publication, PFET has been used to assess thousands of patients across 30+ countries, with approximately nine in ten patients agreeing to an assessment before enrolling in an Axios-partnered patient access program. The methodology behind the tool has also been independently evaluated and published in peer-reviewed research.

But identifying an affordability barrier is only the first step.

The real challenge is having the flexibility to respond to what the assessment reveals.

A patient who needs help covering a co-pay does not necessarily need the same solution as a patient facing delayed insurance reimbursement. Likewise, a patient who can contribute to treatment costs should not necessarily receive the same level of support as someone with little or no ability to pay.

That is why Axios works with a range of financial access models that can be used independently or combined to address different types of affordability barriers.

A Range of Models for Different Affordability Challenges

There is no single model that can address every gap between the cost of treatment and what a patient can pay. Depending on the needs of the patient and the design of the program, Axios can implement different approaches to help patients access and remain on treatment.

Fixed Scheme Support

In some situations, a program may provide patients with a predefined level of support based on the program agreement, without requiring an individual financial eligibility assessment.

This model can be appropriate when a consistent approach is needed across a defined patient population or market.

Tiered Cost-Sharing Support

Not every patient faces the same financial gap, and not every patient requires the same level of assistance.

A tiered cost-sharing model uses financial assessment to help determine what a patient can contribute toward treatment. Support can then be structured around the remaining gap, allowing costs to be shared among relevant stakeholders, which may include pharmaceutical companies, insurers, governments, charities, or NGOs.

This approach can help direct support where it is needed most while creating a more sustainable model for maintaining patient access over time.

Co-Pay Support

For insured patients, having coverage does not always mean treatment is affordable.

In many healthcare systems, patients are still responsible for a portion of treatment costs through monthly or ongoing co-payments. Axios can use financial assessment to determine whether co-pay support is needed and provide assistance designed to help eligible patients cover their share of the cost.

This can help prevent a relatively small but recurring financial obligation from becoming a barrier to starting or continuing treatment.

Compliance Benefit Schemes

In some cases, affordability and adherence can be addressed together.

Compliance Benefit Schemes are designed to encourage patients to remain on treatment by linking additional support to continued adherence. For example, a patient who completes a defined period of treatment may become eligible for additional treatment support.

The model can help patients manage the financial burden of a longer treatment journey while reinforcing the importance of remaining on therapy as prescribed.

On-Time Access to Treatment

Sometimes, the problem is not that treatment is permanently unaffordable.

The problem is timing.

A patient may have insurance coverage or an approved source of funding but still be unable to begin treatment because reimbursement is delayed. They may ultimately have the resources to pay, but not at the moment treatment needs to start.

Axios’ On-Time Access to Treatment model is designed to help address these short-term financing gaps. In partnership with relevant stakeholders and financial institutions, eligible patients can receive access to a short-term, zero-interest financing facility while awaiting reimbursement or other expected funding.

By addressing temporary cash-flow barriers, the model can help prevent unnecessary delays in starting or continuing treatment.

The Right Support Depends on the Problem

The value of having multiple access models becomes clearer when looking at how affordability barriers play out in practice.

In Egypt, for example, an Axios-managed On-Time Access program for oncology and hematology patients addressed a specific challenge: many patients could not afford to pay for treatment while waiting for insurance reimbursement.

Before the program launched, 98% of participating patients could not afford their prescribed medications, and even insured patients often lacked the cash needed to bridge the reimbursement period. Some patients depleted their savings, while others delayed or abandoned treatment.

The barrier was not always a complete lack of insurance or long-term ability to pay. In many cases, it was the gap between when treatment was needed and when reimbursement became available.

By addressing that specific barrier through the On-Time Access model, patients who had previously gone without treatment for up to three months after diagnosis were able to reduce the average time to treatment to approximately two days.

The experience illustrates an important point about affordability: reducing the cost of treatment is not always the answer.

Sometimes the solution is a co-pay program. Sometimes it is cost-sharing. Sometimes it is additional support linked to adherence. And sometimes the patient simply needs a temporary bridge that allows treatment to begin on time.

Understanding the difference is what makes it possible to design support around the actual barrier.

Designing Access Around Real Patient Needs

For nearly three decades, Axios International has worked with healthcare stakeholders to develop sustainable approaches to patient access.

That work starts with recognizing that affordability is not binary. Patients do not simply fall into categories of being able or unable to pay.

There is a spectrum between the full cost of treatment and what an individual patient can realistically contribute. And the reasons for that gap can vary significantly depending on the patient, disease area, treatment, market, and healthcare system.

Axios combines evidence-based assessment with a range of financial access models to help address those differences. Programs can be designed around limited insurance coverage, unaffordable co-pays, gaps between patient resources and treatment costs, delayed reimbursement, or challenges associated with remaining on long-term therapy.

The goal is not to apply the same solution to every patient. It is to understand the barrier, identify the most appropriate model, and create a pathway that gives patients a realistic opportunity to start and remain on treatment.

Because closing the gap between treatment cost and what patients can pay is not about finding one financial solution that works for everyone.

It is about having the flexibility to address the different ways affordability can become a barrier to access, and the right models to respond when it does.