Medicare subsidies may help more women stick with breast cancer drugs

By Lisa Rapaport

(Reuters Health) - Women on Medicare who get subsidies to help defray the cost of drugs may be less likely to stop taking hormone therapy for breast cancer than those who don't get financial assistance, a U.S. study suggests.

Researchers analyzed data on about 25,000 women who had breast cancer surgery and at least one prescription for pills to curb production of the hormone estrogen - which can fuel tumor growth - or pills to stop estrogen from attaching to cancer cells.

Overall, 27 percent of these women received subsidies through a Medicare program for low-income patients that eliminates or substantially reduces out-of-pocket costs for premiums, co-payments, deductibles and medications.

"We found that women with the subsidy (which also means they have fewer financial resources) are more likely to take their medications and continue treatment," said lead study author Dr. Alana Biggers of the University of Illinois- Chicago College of Medicine.

"Women who prematurely stop these therapies are at a higher risk for the recurrence of breast cancer," Biggers added by email.

All of the women in the study were at least 65 years old and enrolled in a Medicare prescription drug plan known as Part D. Researchers followed at least half of the women for more than two years.

Overall, more than 77 percent of the women in the study continued on hormone therapy one year after getting the first prescription and 64 percent were still taking the pills after two years, researchers report in the Journal of Clinical Oncology.

About 77 percent of Hispanic women, 70 percent of black women and 21 percent of white women got a subsidy.

Without subsidies, Hispanic women were three times more likely to discontinue their medication than their counterparts who got financial assistance. Among black women, patients without subsidies were slightly more than twice as likely to stop taking medicine, while white women had 83 percent higher odds of stopping.

This is based on what researchers call "persistence," or how often prescriptions get filled.

Among unsubsidized women, black women were 31 percent more likely than white women to discontinue medication within the first five months. Hispanic women were 32 percent more likely than white women to stop using the pills between 5 and 35 months.

But with subsidies, there wasn't a meaningful difference between black and white women. Hispanic women, meanwhile, became 20 percent less likely than white women to discontinue medication.

Limitations of the study include its observational design, which means it's possible other factors in addition to subsidies may have influenced whether women stayed on their drugs, the authors note.

Even so, the results suggest that subsidies can help reduce disparities in medication use and make it more likely that women stick with their pills, the authors conclude.

"Black and Hispanic women were much more likely to have low-income subsidies, and were also more likely to continue these important medications," said Dr. Nancy Keating, a health policy researcher at Brigham and Women's Hospital and Harvard University in Boston who wasn't involved in the study.

"This suggests that such subsidies might be helpful in lessening disparities," Keating added by email.

With subsidies, women may pay only a few dollars for a 90-day supply of pills that might otherwise cost $100 to $200 out-of-pocket, noted Stacie Dusetzina, a pharmacy researcher at the University of North Carolina at Chapel Hill who wasn't involved in the study.

Because women are encouraged to stay on these pills for at least five years, stopping treatment early can result in worse outcomes and lower survival odds, Dusetzina added by email.

Instead of stopping medication, women should see if they could switch drugs or insurance plans, she advised.

"If costs are the primary reason for stopping therapy early then women should be encouraged to talk with their doctors about alternative treatments since the costs for these drugs vary widely," Dusetzina said. "They could also check with their health insurance plans (Part D plans on Medicare) to find out if there is a cheaper option available."

SOURCE: http://bit.ly/2el8E8G Journal of Clinical Oncology, online October 17, 2016.

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