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Patients With Breast Cancer Who Have Prescription Drug Benefits, Higher Incomes More Likely to Start and Continue Hormonal Therapy

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Key Points

  • Of women with prescription drug coverage, 90% started recommended hormonal therapy, and 81% continued throughout the study.
  • Of women without prescription drug coverage, 82% started hormonal therapy and 66% continued.
  • Women with annual household income less than $40,000 were only about 40% as likely as women from wealthier households to follow through with a doctor’s recommendation to start hormonal therapy.

A University of Colorado Cancer Center study published by Bradley et al in Breast Cancer Research and Treatment showed that patients with breast cancer whose health insurance plans included prescription drug benefits were 10% more likely to start important hormonal therapy than patients who did not have prescription drug coverage. In addition, women with household income below $40,000 were less than half as likely as women with annual household income greater than $70,000 to continue hormonal therapy. Hormonal therapy for patients with estrogen- or progesterone-positive breast cancers can reduce the risk of cancer recurrence by as much as 50%.

“I think what this research says is that general health insurance isn’t enough. You have to have prescription drug coverage,” says Cathy J. Bradley, PhD, Associate Director for Population Studies at the CU Cancer Center and Professor in the Colorado School of Public Health.

Survey Findings

The study used surveys to explore the initiation and continuation of prescribed hormonal therapy, reaching 712 women 9 months after a breast cancer diagnosis, and then again 4 years later (this maintenance therapy generally lasts 5–10 years). Of women with prescription drug coverage, 90% started recommended hormonal therapy, and 81% continued throughout the study. Of women without prescription drug coverage, 82% started hormonal therapy and 66% continued. Women with an annual household income less than $40,000 were only about 40% as likely as women from wealthier households to follow through with a doctor’s recommendation to start hormonal therapy.

The study takes place in the context of two important changes to the landscape of oncology treatment: the development of new, targeted treatments for cancer, which tend to be very expensive and also tend to be taken orally and in patients’ homes, and the Affordable Care Act, which has increased access to health insurance.

“Targeted cancer therapies tend to come in the form of pills taken at home. Many of these new therapies are expensive. This combination of more expensive medicines taken outside the hospital setting means less compliance. Or we see people choosing to alter their prescribed regimens by skipping doses. When you start to dial back from recommended doses, at some point, the drug loses its effectiveness,” Dr. Bradley said.

Need to Broaden Prescription Coverage

Dr. Bradley points to increasing costs of cancer care as a reason for insurers and health-care consumers to rethink the definition of “catastrophic” illness. Her findings show that women without prescription drug coverage, especially if they are from low-income households, may choose not to comply even with a relatively low-cost treatment regimen.

“When someone thinks about coverage for high-cost care, they’re usually thinking about that trip to the hospital that costs $80,000 that could leave them bankrupt. But the fact is that the cost of prescription medicines—even fairly low-cost medications—can also be ‘catastrophic’,” Dr. Bradley explained.

She also notes that efforts under the Affordable Care Act are underway to provide prescription coverage that would guard against undue financial hardship in the case that expensive medicines become necessary.

“We have good evidence that when people feel that a drug is too expensive, they stop taking it,” Dr. Bradley said. “This study suggests that reluctance to insure prescription drugs may result in increased recurrence and poor survival among women with breast cancer, one of the largest groups of cancer survivors.”

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®.


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