Medicare Part D Low-Income Subsidy Program Improves Adherence to Hormone Therapy After Breast Cancer Surgery
Findings from a study of more than 23,000 women suggest that the Medicare Part D Extra Help program, which provides low-income subsidies for medications, improves adherence to hormone therapy after breast cancer surgery in all racial/ethnic groups and reduces racial/ethnic disparities. The study, reported at the 2014 ASCO Quality Care Symposium (Abstract 2), suggests that overcoming economic barriers to medication access may ultimately help reduce breast cancer outcome disparities, especially among racial minorities.
Reducing Health-Care Disparities
“Patients are more likely to take their medications if they are able to afford them,” said lead study author Alana Biggers, MD, MPH, a former internal medicine resident at the Medical College of Wisconsin in Milwaukee, and currently an Assistant Professor of Clinical Medicine at the University of Illinois-Chicago. “Our study shows that federal policy interventions that help cover out-of-pocket costs have the potential to reduce the breast cancer outcome gap by race and ethnicity.”
While breast cancer predominantly affects white women, breast cancer outcomes are worse among black women. In fact, black women are more likely to die of breast cancer than any other group. Breast cancer death rates are also higher among women with low socioeconomic status, regardless of race/ethnicity. Factors contributing to such disparities include poor access to health care, barriers to early screening and detection, lack of adequate health insurance, and genetics (black women more often carry inherited mutations in breast cancer genes).
Study Details
Hormone therapy can reduce risk of breast cancer recurrence and improve chances for long-term survival. In this study, data were collected from a national sample of 23,299 Medicare Part D enrollees with early-stage breast cancer who received hormone therapy (tamoxifen, anastrozole, letrozole, or exemestane) within 1 year of surgery. Overall, 27% of the women were enrolled in the Extra Help low-income subsidy program, which eliminated or reduced out-of-pocket costs for the hormone therapy. The out-of-pocket costs ranged from $155 to $428 per year, on average. Racial minorities were more likely to be enrolled in the program: 70% of black and 56% of Hispanic women received the support, compared to only 21% of white women.
In the first year of hormone therapy, overall adherence rates were similar across all races (64% for white women, 63% for black women, and 67%for Hispanic women). However, racial/ethnic disparities in adherence were evident among the subgroup of women who were not enrolled in the Extra Help program, with white women having significantly higher adherence rates (62%) compared to black and Hispanic women (55%).
In all racial/ethnic groups, adherence rates were higher among women who received the low-income subsidy, compared to those who did not (71% vs 62% for white women; 67% vs 55% for blacks; 71% vs 55% for Hispanics). In addition, although hormone therapy adherence rates declined in years 2 and 3, adherence rate reductions were smaller among those who used the Extra Help program, and this trend was observed in all racial/ethnic groups.
The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
