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The Pink Fund: Financial Relief for Breast Cancer Patients

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Published on November 26, 2019

36% of women are unable to return to their previous place of employment after cancer,” says Molly MacDonald, Founder and CEO of The Pink Fund. How can patients and families deal with the expense? Molly shares how, after receiving a breast cancer diagnosis and going through devastating financial adversity, she felt empowered to help others overcome cancer-related financial toxicity. Watch as Molly explains how The Pink Fund is bridging the gap between the impact of cancer on a person’s livelihood, cost of care and financial support by providing a 90-day buffer to help those in active treatment deal with housing, transportation, utilities and insurance bills. 

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Transcript | The Pink Fund: Financial Relief for Breast Cancer Patients

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrea Hutton:

Hello and welcome, everyone.  I am Andrea Hutton, the breast cancer community manager for Patient Power, and I'm very excited to have as my guest today Molly MacDonald who is the founder of The Pink Fund. 

Molly MacDonald:

Well, thank you for having me.  I'm phoning in or zooming in from Michigan, known as the Mitten State. 

So basically my story is fairly simple.  I was diagnosed with breast cancer on April 1st, 2005.  Seven years previous to that, I had to leave my marriage with my five children ages 4 to 13 after I learned my husband had basically lost all our financial resources totaling about $15 million in a deal that he was pursuing that I not know he was fronting it with our money. 

In fact, in August of 1997 I drove up the driveway to our multimillion‑dollar home and found a note about the size of a rat card on the front door, and when I pulled it off I read that that house was to be auctioned off in 30 days.  And that night I had a really unpleasant conversation with my husband, and that's when I learned that we were $15 million in the hole.  So I—there were some other things going on in our marriage, and that was kind of sealed the deal that I was going to take the children and leave. 

So seven years after that, as I was about to really get my first six‑figure job that I could pull the kids off Medicaid, have them not be on subsidized school lunches and kind of be able to put some money away, I used the transition time between two jobs to have my teeth cleaned and get my mammogram.  And with no family history and never a call back I never suspected that I would be faced with what one of eight of us hear every single year, is that I had breast cancer.  

And while my early‑stage disease was highly unlikely to take my life, it took my livelihood.  And so without that job and the loss of my income and the addition of a Cobra premium, we went into financial freefall very, very quickly.  I had remarried at the time.  My husband—who's awesome.  He's known as Tom Terrific.  And I call him Tom Terrific, because I always say who marries—who would marry a broke, middle‑aged woman with five children, night sweats and a mildly demented mother. 

So he took us all on, but he was in the luxury panel business which wasn't doing well.  So my income represented 60 to 70 percent of what we needed, but now we had this $1,300 a month COBRA treatment to ensure my access to care.  So I was not receiving any child support, I didn't have any alimony, and like about 62 percent of Americans I had less than $1,000 cash on hand.  So within three months the house goes into foreclosure, and at the end of my treatment I ended up standing in line at the food bank to feed our family. 

But during those months that I was in treatment and in particular when I was in radiation every single day for six weeks, I met a lot of other working women like myself who were experiencing what is now termed cancer‑related financial toxicity.  They were on unpaid leaves.  They were concerned that they were going to lose all their retirement.  They wondered if they should put their house on the market.  They wondered if they should hold their kids back from college.  And they wondered if they should even complete their treatment protocol so that they could go back to work.  They were concerned a lot about losing that job if their treatment protocol outlasted their family medical leave. 

And when I went to the social worker and asked if there was an organization that could help us make a non‑medical bill payment, she just looked at me with a blank stare.  And at the time, we were entering into the third quarter of the calendar year so all the social services organizations had used up funding for things like electrical payments and gas payments.  And many of the services were predicated on my previous year's income, which knocked me out of the percentage of federal poverty level to get help. 

Andrea Hutton:

You went from having a certain level of income to then…

Molly MacDonald:

Nothing.  

Andrea Hutton:

…food stamps.  

Molly MacDonald:

Yes.  

Andrea Hutton:

Which is just incredible.  

Molly MacDonald:

Well, not even food stamps.  Food bank.  I couldn't get food stamps, because I didn't qualify.  The food bank was probably the lowest part of that period, because I had in my previous life had groceries delivered.  I would pay somebody to go to the grocery store, and now I know that going to the grocery store is a privilege, but at that point I was in the basement of our church. 

So I had this epiphany, and I thought well, if I can't get help maybe I'm supposed to do something about this.  Maybe I'm supposed to give help.  And once I had that shift in thinking despite my circumstances, which were not‑‑did not change for months, I became so energized and empowered believing that I could do this that I just started putting together a marketing plan.  We did buy a book called How to Form a Nonprofit Corporation, which my husband read all the things about governance.  And he wrote bylaws, and he wrote the application to the government for the 501(c)(3), and we asked a girlfriend to sit on the board.  We traded a European‑designed kitchen table for this heart and ribbon logo, because we had no money to pay the graphic designer. 

And then I started going out on these speaking engagements.  And we had casted my bust the night before my surgery, and it had been cast in 32 pounds of dental stone and painted with battle ribbons across the chest and gold leaf.  And we put a Lucite doll in the middle of it and stuck it in a block of wood, and then we made a sign that said bust stop, octagon‑shaped sign.  And I went out on these bus stop speaking engagements, which might not really fly these days with the MeToo movement, but 13 years ago, 14 years ago it was great.  And I started speaking at Rotary and Kiwanis and Optimist clubs and women's groups and synagogues, anywhere they needed a free speaker. 

Andrea Hutton:

And what were you talking about?  Were you talking about how quickly this kind of diagnosis puts you into a financial hole?  Were you talking about how many women and families this kind of thing affects and the lack of funding for these expenses that are not medical?  What was the stump speech or the bust speech? 

Molly MacDonald:

The bust speech.  So I basically—it was kind of—you know, the bust was my dog and pony show.  So I went out and I shared my sort of riches to rags story and then quickly segued into the challenges that many working individuals have when they're diagnosed and particularly those with more aggressive form of disease that have longer treatment protocols with toxic side effects that make it physically and mentally impossible for them to perform their jobs and some of the decisions that they were making that could potentially affect their long‑term survival.  

So I talked a lot about medical bankruptcy.  I talked progression‑free survival challenges.  I talked about early mortality.  And also the fear that families faced and the fact that‑‑in our situation we were looking at moving into a shelter.  And the price that this cost all of us in our country and our communities when families find themselves homelessness over what I call a medical interruption in their life. 

So my thought was simply that if we could provide a financial bridge of 90 days to help a family cover those housing, transportation, utility bills, then perhaps they would have some time to think about, do I need to put my house on the market if I have a longer treatment protocol?  Is there a vehicle we can sell?  You know, what can we do not to lose everything in the process?  How can I negotiate my payments to my provider?  So we got started

And fast‑forward to where we are today, we've paid out about 4 million in bills to patients' creditors, for housing, transportation, utilities and insurance. 

Andrea Hutton:

Can you share some stories about the people that you've helped?  How do they find you and how do you make decisions and what are the grants? 

Molly MacDonald:

So because we don't advertise—we do have a quarterly ad, full‑page ad in Breast Cancer Wellness magazine, but it's covered by me writing a column on financial wellness, so it's a wash.  Our website is extremely well optimized, and so it's easy to find us.  You plug in breast cancer financial aid and after some of the paid listings‑‑we won't be right there on the first page of any Google search.  And then most social workers and navigators know about us just through patients telling them or through searching for their patients themselves.

The way that patients find us, it says to get help click here.  They answer some prequalifying questions that help determine whether they would qualify according to our guidelines, which are simply that you must be in active treatment, which is surgery, chemotherapy, radiation.  It does not include the aromatase inhibitors, because those typically do not preclude you from being able to work.  So it's really that heavy, active treatment period.  You must be able to show a reduction in income.  It doesn't have to be 100 percent reduction, but it can be a percentage of lost income.  And then your family household income must be at or below 500 percent of the federal poverty level. 

Andrea Hutton:

And are you flooded with requests? 

Molly MacDonald:

We are.  We received about 4‑ to 5,000 this last year.  We're only able to support about 10 percent of those, but it's because they don't ever fill out the full application are or they don't really qualify.  So many patients are pretty desperate and they'll just check off that they do qualify according to those guidelines, and then they fill out the application and we can't help them.  They're either out of treatment, they maybe didn't lose any percentage of their income, and 95 percent of the applications arrive incomplete, and even though we work really hard to chase down that information that's missing we don't get it. 

Andrea Hutton:

Hmmm.  So your help is out there, but it takes a little bit—not that much, but a little bit of effort on the part of the patient to make sure that they're providing you with the accurate information to make sure that they qualify. 

Molly MacDonald:

So the patients think that our application is challenging, but the application is no more challenging than procuring a mortgage.  We don't pull a credit report, but we require supporting documentation.  So we get your copies of your tax returns, two months of bank statements, copies of the bills you want paid and your medical—not your medical records but a letter from your treating oncologist or provider indicating your treatment start date, projected end date and what kind of treatment you're receiving. 

And the reason we ask for all that is that our donors are giving us their hard‑earned money, and we want to steward those properly, and without documentation, if we went just on narrative, there would be no way that we could make an informed, factually‑based decision. 

Andrea Hutton:

And what are you finding is the result of these amazing grants that you're giving for 90 days?  I mean, I'm sure you've heard from many people whom you've helped to say, this is a gift that has given us this time, and as a result we've been able to plan for our future or—I can't even imagine. 

Molly MacDonald:

So a lot of it is they can sleep at night now, that they're able to sleep.  That is probably the biggest one.  Second to that is that it gives them that thing that you cannot quantity or qualify, which is hope.  And when somebody comes alongside you in a very critical situation and removes some burden from your life, particularly a financial burden, it gives you the ability to step forward to the next day, the next week and the next month.  And in the thank‑you notes, which we received, which we have our committee read every month when they make the funding decisions, we ask them to read them out loud so they understand the impact of their work.  The big thing that comes out all the time is hope.  The relief and hope. 

Andrea Hutton:

I mean, 90 days doesn't seem like that much and yet it's huge.  

Molly MacDonald:

Well, many organizations—so there are other organizations out there that do some of the work that we do in different ways.  And they might do a one‑time grant.  Or they might send a $25 or $100 gift card.  They might send a grocery card.  And we tell patients that you're going to have to cobble together lots of resources, and we want them to. 

So we refer them to Cancer Care, which has a strong list of resources both nationally and state‑wide.  And then also we refer them on the medical side for co‑pay assistance to the PAN Foundation, which you can log into that and through their fund finder you can be alerted immediately when a fund opens for a type of medication you may be taking, and you can apply for support. 

So we know that while we can't take care of the full problem we're hoping that our little bridge allows them to walk over to other organizations where they can get additional support.  And that is a challenge.  One of my big goals would be—and I don't care who does it—but if there was a portal like the Common App for college, where you filled out one application for what type of disease you had, not even necessarily cancer, and all of a sudden, based on what you filled out, probably income‑based, it would send that application to—and I'm going to make this up‑‑organizations in your ZIP code, organizations in your county, organizations in your state, national organizations.  And then you would find out you might get funding from all of them or some of them. 

That would be a dream of mine and make it just so easy for a patient to cobble together those resources.  You know, average treatment for breast cancer is six to nine months, and that includes somebody like me who had two surgeries in May and stopped in August.  So my treatment was only four months, but some women are in treatment 12 to 18 months.  I don't how long you were, but it can be a long haul. 

Andrea Hutton:

Ten years and counting, so.  So, yeah, it can be a very, very long haul, and depending on what your financial and insurance situation is and co‑pay situation it, it's incredibly complicated.  I think that the idea of having a database is an amazing idea.  I hope you're working on it.  I think you might be the person to make that happen. 

Molly MacDonald:

I think that we could probably put together a list of companies who have the financial resources to help deliver or develop that, and I think it would be a huge service.  And we could start with something pretty simple like maybe just cancer. 

Andrea Hutton:

I mean, the fact that you are already partnering and providing access and communication with other organizations that are providing additional resources is the beginning.  As you said, it's a bridge.  And for a lot of families that's exactly what's needed.  So aside from a national database and obviously more—more funding for your organization and others, what else—what else do you hope for the future?  

Molly MacDonald:

So one of the exciting things that's happening is the University of Michigan through Dr. Reshma Jagsi's team, her team, and she's on the board of ASCO and at San Antonio Breast, are using our patient data with their opting in, and they are being compensated for a research study on this problem.  And so that will help us potentially identify other interventions that we can execute on behalf of patients and a way to an even larger more robust study. 

We are also going to begin a series of infocasts.  I don't want to call them podcasts, but infocasts where we will be working with experts to help patients understand how to read their Explanation of Benefits forms, how to—and we can't use the word optimized your insurance, but how to understand what your insurance will cover and find out if there's other types of insurance that you might qualify for, how to negotiate a payment plan with your provider plan for your deductible, how to access other resources. 

And then that will be on our YouTube channel but also be on our website, and there'll be downloadable materials that accompany those.  Our application has been translated into Spanish, and we're hoping to launch that soon.  And then after that it will be translated into Arabic.  So we hope to book into our program on the front end with a lot of what I would call financial and health literacy data to try to help patients understand what they can do. 

And then on the back end we are going to work on building patients' financial health for those patients who need to procure a new source of employment, and we have plans to launch that with a national organization as well.  But we've done a study.  Our study showed that 36 percent of women could not return to their previous employment. 

Andrea Hutton:

Thirty-six percent. 

Molly MacDonald:

Hm‑hmm.  And the reasons were that their treatment protocol outlasted their FMLA.  They were fired, they quit, or they went on disability. 

Andrea Hutton:

It is not surprising to me because I work with women in treatment all the time, but I think for a lot of people out there they assume that once you're finished with treatment your life just kind of goes back to normal.  You might take this little hiatus to get well, and then just kind of pick up where you left off.  But we know that that's not what happens for patients.  For some it is a life‑long commitment to treatment, and for others that, as you said, the effects of the financial effects of treatment can well outlast any initial help that they thought they had or, you know, issues with their employment as well. 

Molly MacDonald:

Well, see, now some patients—and you're I'm sure very fully aware, probably more so than I—have long‑term side effects from treatment.  They aren't going to go away, and they may need new skill sets for new types of jobs.  Or they may need part‑time work, something in the gig economy that helps them patch together enough income or some income. 

And then on the metastatic, in the metastatic area we do have a fund for women awaiting Social Security Disability.  That fund will pay that patient's bills for five to six months with a cap of about $6,000.  So it's not a lot, but it does remove some of the financial burden as they're on proving—in that unpaid work period proving that they really can't work.  If the bills get passed that that waiting period is eliminated, which would be amazing, then we would probably use that money in the Mary Herzog Fund possibly to help patients travel to clinical trials, some kind of—something to be removing some of the financial burdens of the disease. 

Andrea Hutton:

Does your organization have a calendar of grants, or do you give out money year-round just depending on the need?  How do you work? 

Molly MacDonald:

Since then we've never missed a month.  So we don't like the idea of opening closed funding, but we know it's necessary.  Particularly there are many funds where there's just X number of dollars donated to an organization and then it goes away, which is the case for us with the Mary Herzog fund.  So that doesn't really have open and closed funding cycles, but when the money's gone, the money's gone.  But then we move that patient into our general fund so they still can get 90 days, some relief. 

We hope to be able to grow our program enough that we can bump our maximum grant which currently is $3,000, you know, to $4‑ to $5‑ to $6,000 or add a month or two onto it.  The idea really is to try to do what's best for the patient based on the money that we have.  

But what we have done is if our budget projections haven't met what is actually the revenue that's come in, then instead of making somebody's house payment we'll make their car payment.  If we can't make their car payment, we'll make their utility payment.  So what we do is we provide some form of financial relief, and while that might not be enough, it is interesting how that little bit of hope and that little bit of relief helps them. 

Andrea Hutton:

Well, I don't think we can overstate how that little bit of help is actually a great big help, and so I very much, on behalf of our breast cancer patient community, appreciate all the work that you're doing and hope that you continue to be successful.  And I know that this will help a lot of women find the resources and support that they need as well. 

Molly MacDonald:

Thank you. 

Andrea Hutton:

Thank you for joining us.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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