Even with insurance, many Medicare and underinsured patients struggle to afford prescription copays and deductibles, affecting treatment adherence.
For many patients, a serious diagnosis does not just bring medical uncertainty, but immediate financial stress. For the HealthWell Foundation, that reality has shaped its work from the very beginning.
Xtalks spoke with Michael S. Heimall, FACHE, President and CEO of the HealthWell Foundation, about the organization’s mission to reduce financial barriers to care, the shifting policy and insurance landscape and how the broader life sciences and health care community can help ensure that patients are able to access and stay on the treatments they need.
Since HealthWell was founded in 2003, its work has centered on patients who are insured but still struggle to afford care. The foundation focuses on people living with chronic and life-altering diseases, including cancer and heart and liver conditions and many of those they help are Medicare beneficiaries trying to manage medical costs on fixed incomes.
“What we have found over the years is that Medicare recipients in particular seem to struggle the most on fixed incomes with being able to afford their copays for prescription medications,” Michael said.
The foundation’s experience has consistently shown that financial strain affects how patients manage their care. Those who have difficulty meeting copay obligations may skip doses, delay filling prescriptions or alter treatment plans. The impact can extend beyond medications.
“When we look at things as food as medicine, they may change their diet, their shopping habits, go to less healthy options so that they can afford to pay their mortgage, keep their lights on and afford their prescription drugs,” he explained.
How HealthWell Supports Patients
HealthWell delivers assistance through disease-specific programs known as “disease funds.” Each “fund” is built around a specific condition and designed to help patients manage the out-of-pocket costs that can come with treatment.
Over the past two decades, the foundation has established 100 funds, each designed to help patients manage out-of-pocket costs associated with a particular condition.
To qualify for support, patients must meet three criteria. Their household income must be below 500% of the federal poverty level. They must have some form of insurance coverage contributing to the cost of treatment. And they must have a confirmed diagnosis for the disease associated with the fund to which they are applying.
This structure allows the foundation to provide targeted financial help while operating as a fully independent charity. Grants are not loans and are never expected to be repaid.
Priorities in a Changing Policy and Insurance Environment
When Michael looks ahead to 2026, he sees a health care landscape that has already changed dramatically over the past few years, particularly with the passage of the Inflation Reduction Act.
The law introduced a cap on annual out-of-pocket spending for Medicare Part D prescription drugs, which will be set at $2,100 per year beginning in 2026. Michael views this as an important and welcome development for patients. At the same time, he emphasized that substantial need remains, particularly in Medicare Part B, which covers many infused and physician-administered therapies.
Keeping this need in mind, Michael said three priorities stand out for the foundation.
The first is awareness. The foundation wants patients and care teams to know that independent charitable assistance exists before a financial crisis occurs.
“We want to make sure that every patient in America knows us before they need financial assistance so that when they do, if they are diagnosed with cancer or some other life-altering illness, they know where they can turn for assistance,” Michael said. “So many patients don’t know that they can come to independent charities like HealthWell.”
The second priority is sustaining the foundation’s donor base at a time when the policy environment is changing. While the IRA has reduced individual out-of-pocket costs, overall demand for assistance has continued to grow.
In 2024, HealthWell awarded over 311,000 grants totaling about $1.23 billion. In 2025, the foundation awarded more than 443,000 grants, and Michael expects demand to continue rising in 2026.
“While the individual out-of-pocket expenses for Medicare Part D beneficiaries have gone down, the aggregate need continues to expand,” he said. “So being able to make sure our donors are aware of that and we’re able to sustain the programs that we’ve been able to offer to patients is really important.”
A third priority is innovation in how the organization responds to emerging pressures in the insurance and treatment landscape.
In November, HealthWell opened an ACA Marketplace Insurance Premium Assistance Fund to help individuals with incomes below 200% of the federal poverty level cope with sharp increases in marketplace premiums. Demand was immediate and intense.
“We were able to keep that fund open for about 36 hours. There was so much demand for it,” Michael said. The foundation has since worked to reopen the fund and continues to seek donor support to maintain it.
He also highlighted gene therapy as an area that will pose growing challenges for affordability.
“Gene therapy is a wonderful breakthrough. In a lot of cases, one treatment can cure a chronic and life-altering disease, but they’re outrageously expensive, and an overwhelming majority of folks may not be able to afford those, and their insurance may not be able to cover it,” he said.
Another trend he is closely watching is the expansion of high-deductible health plans.
“My concern is many patients will not understand the impact of a high-deductible health plan until they come up with something like a cancer diagnosis and they have to pay $7,000 or $10,000 out-of-pocket before their insurance coverage kicks in,” Michael noted.
The Role of Advocacy Partnerships
For Michael, partnerships with patient advocacy organizations are essential to reaching patients and understanding where support is most urgently needed.
He pointed to the launch of the foundation’s Parkinson’s disease fund in early 2025 as an example of how advocacy groups can help rapidly connect patients with support.
“When we launched a Parkinson’s disease fund, several of the Parkinson’s advocacy groups were incredibly supportive of us in getting the word out to their patient populations,” Michael said.
These groups often help highlight areas of unmet patient need within specific disease communities. As new therapies become available and patient affordability challenges increase, independent charities like HealthWell consider whether and how they can provide support consistent with their mission.
The challenge, Michael said, is building meaningful and compliant, two-way relationships that allow organizations to amplify one another’s messages and coordinate around patient needs. HealthWell participates in the National Health Council alongside roughly 180 other organizations, using that forum to build connections and share strategies.
“A lot of the advocacy groups are very focused on research, as they should be,” he said. “But once that research comes to the marketplace, how do we help patients afford it?”
Engaging the Broader Life Sciences and Health Care Community
Michael believes one of the greatest barriers to expanding HealthWell’s impact is limited awareness, even among health care leaders.
Before joining the foundation, he spent 36 years in federal hospitals and health care systems, including about 14 years as a CEO. Yet he had not encountered HealthWell until seeing the job posting for his current role.
“There’s a lot of confusion over what HealthWell does,” he said. “Sometimes we’re perceived to be a catastrophic reinsurance company or a supplemental reinsurance policy. We are not. We’re a completely independent charity. Grants are grants that are free to the patient and never expected to be repaid or anything.”
He sees particular opportunity to raise awareness of independent charitable assistance among smaller and emerging biotechnology companies as new therapies move through clinical development and into clinical use.
“Many of those organizations, when their treatment comes to market, want to make sure patients who need it can afford it,” he said. “HealthWell’s role is to ensure that any support received is accepted without influence over our programs or eligibility criteria while keeping the focus on patient need.”
Within hospitals and clinics, he emphasized the importance of care navigation and patient advocacy.
“Doctors should not have to worry about whether a patient can afford the best treatment for their disease,” Michael said. “There are a number of resources out there where we can educate clinicians on the assistance that’s available, and we can work with their patient advocates and their case managers and care navigators to link the patient up with the right resources.”
Meeting Patients at the Pharmacy Counter
One of the most immediate points at which affordability becomes visible is the pharmacy counter.
About a third of HealthWell’s referrals come from provider groups, and another third come from pharmacies themselves. Often, the moment a patient learns the size of a copay is when financial stress becomes acute.
“The pharmacist says, ‘Here’s your copay of $500,’ and the patient is shocked because they can’t afford it,” Michael said. “That $500 was going to go to buying groceries or to paying their utilities that month.”
In many cases, pharmacists are able to help patients apply for assistance on the spot. Using HealthWell’s online system, income can be verified through a soft credit check, and insurance coverage can be confirmed. As soon as diagnosis verification is confirmed, the patient will have access to their grant.
Overall, HealthWell’s mission is centered on removing cost as a barrier at the exact moment patients need treatment.
“Often, if eligibility criteria are met, the patient can walk out with their prescription and the grant covering their initial copay on that first day,” Michael said.
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