It appears that women with early breast cancer who are prescribed treatment with aromatase inhibitors (AIs) are more likely to discontinue or not follow through with this therapy if insurance copayments are high. These results were presented at the 2010 San Antonio Breast Cancer Symposium.
Treatment of hormone receptor-positive breast cancer often involves hormonal therapies that suppress or block the action of estrogen. These therapies include tamoxifen as well as agents known as aromatase inhibitors. Tamoxifen acts by blocking estrogen receptors, whereas aromatase inhibitors suppress the production of estrogen in postmenopausal women.
It’s not uncommon for women to fail to adhere to treatment with hormonal therapy. Previous studies have indicated that a woman’s age, the severity of side effects of hormonal therapy, and whether or not she believes the medicine is effective can influence her adherence to treatment. Little is known, however, about how the expense of these therapies may affect rates of adherence.
The impact of insurance copayments on adherence to AIs was evaluated in a study of 8,110 women aged 50 to 65 and 14,050 women aged 65 and older. The researchers investigated two different types of non-adherence: whether patients stopped using AIs entirely and didn’t get any refills or whether patients did not take AIs as prescribed (did not refill prescription on time or did not take AIs at least 80% of the time). Researchers categorized copayments as follows: less than $30, between $30 and $89.99, and $90 or more.
These results indicate that higher prescription copayments limit the use of AIs, making patients more likely to either discontinue treatment or not take AIs as prescribed and that older women are more likely to be affected. Because AIs can be highly effective, the researchers suggest that “future public policy efforts should be directed towards reducing financial constraints as a means of increasing the complete use of these medications.”
Reference: Hershman DL, Neugut AI, Subar M, et al. Association between prescription co-payment amount and compliance with adjuvant aromatase inhibitor therapy in women with early stage breast cancer. Presented at the 33rd annual San Antonio Breast Cancer Symposium, December 8-12, 2010. Abstract S6-4.