Newswise, November 19, 2015 — A University of Colorado Cancer
Center study published in the journal Breast Cancer
Research and Treatment shows that breast cancer patients whose health
insurance plans included prescription drug benefits were 10 percent 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 percent.
“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, professor in the Colorado School of Public Health, and the
paper’s first author.
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 percent started recommended hormonal therapy and 81 percent continued
through the study.
Of women without prescription drug coverage, 82 percent
started hormonal therapy and 66 percent continued. Women with annual household
income of less than $40,000 were only about 40 percent 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,” Bradley says.
Bradley points to increasing costs of cancer care as a reason
for insurers and healthcare 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 says.
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,” Bradley says. “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.”
