Subsidies help breast cancer patients adhere to hormone therapy

A federal prescription-subsidy program for low-income women on Medicare significantly improved their adherence to hormone therapy to prevent the recurrence of breast cancer after surgery, according to a new study. The results were presented at a press conference in advance of the American Society for Clinical Oncology Quality Care Symposium in Boston, Massachusetts.

“Our findings suggest that out-of-pocket costs are a significant barrier” to women complying with hormone therapy, said presenter and lead investigator Alana Biggers, MD, assistant professor of clinical medicine at the University of Illinois at Chicago College of Medicine. Programs that lower these costs can “improve adherence and, hopefully, breast cancer outcomes for low-income women,” she said.

Breast cancer is a leading cause of cancer-related deaths for women of all races, but survival rates differ by race and socioeconomic status, with African American women and women of low income having higher rates of death.

Hormone therapy, such as tamoxifen or aromatase inhibitors, is usually taken for 5 years following mastectomy or surgical resection of breast tumors. Hormone therapy can significantly reduce the risk that that cancer will return. Poor adherence to postsurgical hormone therapy regimens is associated with diminished chance of survival.

Biggers and her colleagues looked at data from the US Centers for Medicare and Medicaid Services on adherence to hormone therapy for 3 years after breast cancer surgery. The 23,299 women, all 65 years or older and enrolled in Medicare, were 86% white, 7% African American, 4% Hispanic, and 2% other racial backgrounds. All had had either a mastectomy or lumpectomy in 2006 or 2007.

A total of 27% were enrolled in the Medicare Part D low-income subsidy, also known as the Extra Help program, which helps qualifying persons pay for prescriptions. For the purposes of the study, medication adherence was defined as refilling a prescription as instructed 80% of the time or better.

“When we looked at women not enrolled in the subsidy plan, we saw that African American and Hispanic women had lower rates of adherence than white women,” Biggers said. “But when we added in data from women enrolled in the subsidy plan, these disparities disappeared, and we saw that adherence rates improved and evened out across races.”

The average rate of adherence over 3 years for women enrolled in the Extra Help program was 68%, compared to 52% for women not in the program. Overall, 61% of women remained adherent to their hormone therapy over 3 years, with African American and Hispanic women having higher adherence rates of 62% and 64%, respectively, than white women at 58%. Biggers attributes this to the higher enrollment in subsidy programs among African American women (70%) and Hispanics (57%) compared to white women (21%) or women from other racial backgrounds (60%).

The data also showed that women enrolled in the Extra Help program have similar rates of adherence year after year, while adherence dropped over 3 years among women not in the program.

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