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 FemaraR (letrozole) ArimidexR (anastrozole), and AromasinR (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.?

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Higher Copayments May Limit Use of Breast Cancer Therapy

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.

21.2% of the 8,110 patients aged 50 to 65 stopped taking AIs.Of the patients aged 50 to 65 who stayed on treatment during a two-year period, 10.3% did not take AIs as prescribed.Almost 25% of the 14,050 patients aged 65 and older stopped taking AIs.8.9% of patients aged 65 and older who continued taking AIs did not do so as prescribed. Women 65 years and older were more likely to discontinue AIs if their copayments were greater than $30.Women younger than 65 years became more likely to discontinue AIs when copayments were $90 or greater. It was also noted that when AIs were prescribed by a primary-care doctor, women were less likely to stay on treatment. This was also the case among women prescribed many other medications in addition to AIs.

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.

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