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Higher Copayments Reduce Use of Aromatase Inhibitors for Breast Cancer

 

Among breast cancer patients treated with an aromatase inhibitor (a type of hormonal therapy), those with high insurance co-payments are more likely to quit aromatase inhibitor treatment or not to take it as directed. These results were published in the Journal of Clinical Oncology. 

   

Each year roughly 200,000 U.S. women are diagnosed with breast cancer. Many of these breast cancers are hormone receptor-positive, meaning that exposure to estrogen and/or progesterone can cause them to grow. 

   

Treatment of hormone receptor-positive breast cancer often includes hormonal therapies—such as tamoxifen or an aromatase inhibitor—that suppress or block the action of estrogen. Tamoxifen acts by blocking estrogen receptors, and aromatase inhibitors suppress the production of estrogen in postmenopausal women. Aromatase inhibitors include Femara® (letrozole) Arimidex® (anastrozole), and Aromasin® (exemestane).  

   

For breast cancer patients who are prescribed hormonal therapy, it’s important to follow the physician’s instructions in order to achieve the best outcome. Several factors—including cost—may make it difficult to stick with treatment, but little research has been done on how medication cost affects adherence to hormonal therapy.  

   

To evaluate whether insurance co-payments affect a woman’s willingness or ability to complete aromatase inhibitor treatment, researchers conducted a study of more than 8,000 women between the ages of 50 and 65 and more than 14,000 women age 65 or older. All the women had insurance coverage for prescription drugs and had been given a prescription for an aromatase inhibitor after surgery for early-stage breast cancer. 

   

  • Among women between the ages of 50 and 65, 21% stopped aromatase inhibitor earlier than was recommended, and an additional 11% took less than 80% of the prescribed doses. 
  • Among women age 65 or older, 25% stopped aromatase inhibitor earlier than was recommended, and an additional 9% took less than 80% of the prescribed doses. 
  • In both age groups, stopping treatment early was more common among women who had a higher number of other prescriptions and women whose aromatase inhibitor prescription came from someone other than an oncologist. 
  • Women who had a high prescription co-payment were also more likely to stop AI treatment early. Young women were more likely to stop treatment early if their co-pay was more than $90 for a three-month supply. Older women were more likely to stop treatment early if their co-pay was more than $30 for a three-month supply.  

   

This study suggests that higher drug costs lead some breast cancer patients not to complete their full course of hormonal therapy. The researchers conclude “Because noncompliance is associated with worse outcomes, future policy efforts should be directed toward interventions that would help patients with financial difficulties obtain life-saving medications.” 

   

Reference: Neugut AI, Subar M, Wilde TY et al. Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. Journal of Clinical Oncology. Early online publication May 23, 2011.