Mr S takes you aside after his wife enters the chemotherapy room.“Doctor, how much longer is this going to continue? We already sold our house, but the20% copayonour $14,000-a-monthchemotherapy bills (paclitaxel, carboplatin, trastuzamab, and pamidronate) are adding up quickly. I’m glad she’s doing OK, but do you think she’ll last another 3 months? A year? I don’t mean to sound morbid, but I need to plan.” Mrs O is a 72-year-old rural widow on a fixed income and is enrolled in Medicare without supplemental insurance. She has stopped taking her aromatase inhibitor because she reached her “donut hole” of $2,400 for all of her chronic medicines. She searched for the least expensive medication, but 30 tablets of letrozole costs $266, anastrazole costs $279, and exemestane costs $266. Should she go back to generic tamoxifen at $22 per month?(All prices are from www. drugstore. com.). Ms S is a 43-year-old single mother whose metastatic breast cancer is shrinking on sixth-line chemotherapy with fluorouracil, leucovorin, and mitomycin injections 5 days in a row, monthly. She asks if you can do something else instead, because she cannot afford the daily $35 copayment. Your practice is obligated to collect this under insurance law.