Women Without Prescription Drug Coverage Less Likely to Start Hormonal Therapy

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After surgery, women diagnosed with hormone-receptor-positive breast cancer usually take hormonal therapy medicine to reduce the risk of the cancer coming back (recurrence). Hormonal therapy medicines work in two ways:

  • by lowering the amount of estrogen in the body
  • by blocking the action of estrogen on breast cancer cells

There are several types of hormonal therapy medicines. Tamoxifen, a selective estrogen receptor modulator (SERM), is one of the most well-known. Tamoxifen can be used to treat both premenopausal and postmenopausal women. In 2005, the aromatase inhibitors:

  • Arimidex (chemical name: anastrozole)
  • Aromasin (chemical name: exemestane)
  • Femara (chemical name: letrozole)

were shown to be more effective at reducing recurrence risk in postmenopausal women and are now used more often than tamoxifen to treat women who’ve gone through menopause. Aromatase inhibitors aren’t yet used to reduce recurrence risk in premenopausal women, though some studies are investigating this option.

Hormonal therapy often is taken for 5 years after surgery. Still, research has shown that taking tamoxifen for 10 years instead of 5 years after surgery reduced the number of recurrences and improved overall survival. Many doctors wonder if the aromatase inhibitors may offer more benefits if taken for longer than 5 years.

Both tamoxifen and aromatase inhibitors can cause side effects. Tamoxifen may cause hot flashes and increase the risk of blood clots and stroke. Aromatase inhibitors may cause muscle and joint aches and pains. Less common but more severe side effects of aromatase inhibitors are heart problems, osteoporosis, and broken bones. Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either don’t start taking the medicine or stop taking it early. This is due to a number of reasons, but side effects and cost are two of the most common.

A study has found that women diagnosed with early-stage, hormone-receptor-positive breast cancer with no prescription drug coverage were less likely to start hormonal therapy than women who had insurance coverage for prescription drugs. The study also found that women with a household income of less than $40,000 were less likely to complete a full course of hormonal therapy compared to wealthier women.

The research was published in the November 2015 issue of Breast Cancer Research and Treatment. Read the abstract of “Prescription drug coverage: implications for hormonal therapy adherence in women diagnosed with breast cancer.”

To do the study, the researchers surveyed 712 women 9 months after they had been diagnosed with early-stage, hormone-receptor-positive disease. The women were surveyed again 4 years later. All the women were diagnosed between June 2005 and February 2007.

The survey asked about the women’s income and insurance coverage, including prescription drug coverage, as well as their hormonal therapy treatment.

Of women with prescription drug coverage:

  • 90% started hormonal therapy
  • 81% continued to take hormonal therapy at the 4-year mark

Of women without prescription drug coverage:

  • 82% started hormonal therapy
  • 66% continued to take hormonal therapy at the 4-year mark

Women with an annual household income of less than $40,000 were much less likely to start hormonal therapy compared to women who had higher household incomes.

"I think what this research says is that general health insurance isn't enough. You have to have prescription drug coverage," said Cathy J. Bradley, Ph.D., associate director for Population Studies at the Colorado University Cancer Center, professor in the Colorado School of Public Health and the paper's first author.

Dr. Bradley said the increasing costs of cancer care are 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 not be able to afford even 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 said.

It’s important to know that efforts are underway to have the Affordable Care Act to provide prescription coverage that would guard against undue financial hardship in the case that expensive medicines become necessary.

It’s also important to know that all the aromatase inhibitors are available as generic drugs. Tamoxifen also is a generic drug.

A generic drug has the same active ingredients as an original, brand-name drug, as well as the same dosage, risks, and benefits. The only thing that’s different is the name. Generic drugs usually cost much less than brand-name drugs. Generic versions of drugs come to the market when the patent has expired on the brand-name drug.

This study supports earlier research showing that many women have trouble paying for breast cancer treatment. One study found that about 25% of diagnosed women go into debt to pay for treatment.

These results are troubling. It’s worrisome to know that so many women are having financial problems because of breast cancer, and it’s very upsetting to know that women are skipping treatments because of medical costs.

If you’ve been diagnosed with breast cancer and don't have insurance or are unemployed, paying for treatment may seem overwhelming. Don't panic, and don't skip any treatments or doctor's visits. There are resources available to help you.

Someone at your doctor’s office may be able to give you a list of organizations that offer financial assistance for breast cancer medicines and care, as well as local organizations that offer financial assistance for your practical needs such as transportation, food, and child care. Many pharmaceutical companies have set up special funds to help pay for the cost of their medicines.

In the Breastcancer.org Paying for Your Care section, there are resources based in the United States that can help you. If you live outside the United States, ask your doctor about resources in your country.

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