Prescription Coverage Impacts Treatment Adherence in Breast Cancer, Even for Low-cost Drugs

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. 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%.

These findings were published in Breast Cancer Research and Treatment (doi:10.1007/s10549-015-3630-x).

"I think what this research says is that general health insurance isn't enough. You have to have prescription drug coverage," said first author Cathy J. Bradley, PhD, associate director for Population Studies at the University of Colorado Cancer Center and professor at the Colorado School of Public Health in Aurora.

The study used surveys to explore the initiation and continuation of prescribed hormonal therapy, including 712 women 9 months after a breast cancer diagnosis and then again 4 years later (this maintenance therapy generally lasts 5 to 10 years).

Of the women with prescription drug coverage, 90 started recommended hormonal therapy and 81% continued it through the study. Of the women without prescription drug coverage, 82% started hormonal therapy and 66% continued it. Women with annual household income of 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 2 important changes to the landscape of oncology treatment: the development of new, targeted treatments for cancer, which tend to be very expensive and are taken orally  and outside of the clinic setting; 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," Bradley said.

Bradley pointed 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," Bradley said.

She also noted 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," Bradley said. "This study suggests that reluctance to insure prescription drugs may result in increased recurrence and poor survival among women with breast cancer, 1 of the largest groups of cancer survivors."

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