Financial Assistance Helps Keep People on Breast Cancer Medicine

A recent study in the Journal of Clinical Oncology looked at data from the Medicare Part D prescription program to see if a person’s race and whether they received financial assistance from the government affected how they kept up with treatment.

The study looked at women taking hormonal therapy for breast cancer and found those receiving assistance for their medicine were more likely to stay on that medicine, regardless of race or ethnicity, than women who did not.

Background

Hormonal therapy interrupts hormones in the body that tell certain breast cancer cells to grow and spread. It can lower the chance of breast cancer coming back. But studies have found that a third to half of people given hormonal therapy do not stay on the medicine for the recommended time. Stopping a medicine or not taking it as often as the doctor recommended can cause it to have less of an effect.

Other studies have found that black women and women with low incomes are more likely to stop taking hormonal therapy than women of other races and higher incomes. Black women with breast cancer also have a higher overall chance of dying from the disease than white women.

Medicare Part D provides coverage for medicine through private health insurance plans, but it has a notable “coverage gap,” a period during which you are responsible to pay for your own medicines. People with low income and few assets are given subsidies, financial assistance from the government, to pay the premiums and co-pays from their Part D plan as well as the costs of medicines during the coverage gap. This study aimed to see if getting the Low-Income Subsidy changed how often women stuck to their hormonal therapy prescription.

Design

This study looked at data from the Medicare Part D program. Women included were at least 65 years old, had breast cancer surgery in the years 2006 or 2007, and had a prescription for hormonal therapy filled within one year of that surgery. It was an observational study, which means it looked at existing information and wasn’t able to control for other factors by randomly assigning people to different actions, which is done in a controlled randomized trial.

Medicare Part D tracks how much medicine participants get from the pharmacy through their plan. Researchers used that data to compare the number of pills women got from the pharmacy to the number they should have taken according to their prescription. They used records from 25,511 women and looked at how often they refilled hormonal therapy prescriptions over a median of 2.2 years.

Most people were given a prescription for 90 days of hormonal therapy pills, so women who went more than 90 days without requesting a refill from the pharmacy were considered not persistent, meaning they had stopped taking the medicine.  Researchers also looked at adherence, how well a person stayed to the schedule their doctor prescribed. For example, a person may be prescribed a pill to take once every day. If researchers found a woman did not pick up enough pills to meet that prescription over a period of time, she was considered not adherent.

The study also explored if a person’s race impacted whether they adhered or persisted. For this study, researchers looked only at women who identified as white, black or Hispanic, as those were the categories for which there was enough data.

Results

Whether women received subsidies differed by race:

• 77 percent of Hispanic women received financial assistance.
• 70 percent of black women received financial assistance.
• 21 percent of white women received financial assistance.

Researchers found women who did not get financial assistance were more likely to stop taking hormonal therapy.

Women who were black or Hispanic were more likely than white women to stop taking the medicine if they didn’t get financial assistance. But if they did receive financial assistance, these differences were not seen.

Overall, women who were black or Hispanic were more likely to still be taking hormonal therapy 2 years after starting treatment. This may be because they were the groups most likely to get financial assistance:

• 70 percent of Hispanic women were still taking the medicine at 2 years.
• 69 percent of black women were still taking the medicine at 2 years.
• 61 percent of white women were still taking the medicine at 2 years.

Rates of persistence were different for each race, but women of all races were more likely to stay on their medicine when they got financial assistance than women of any race who did not receive assistance.

What This Means for You

Taking medicine as prescribed by your doctor is important to treat breast cancer and lower the chance that it will return. Studies like this show there are reasons beyond side effects that cause people to stop taking medicines. This can help providers and policymakers think about how to design treatments or programs to make it easier, more likely and more affordable for you to get the full benefit of your medicines.

Race and ethnicity are an important part of any discussion about treatment. Researchers have found that race sometimes affects how you experience breast cancer. Because many people of color are also low income and live in areas that have few resources, differences that come from financial issues are sometimes thought to be tied to race. Researchers pointed to this effect in a previous study of women with private insurance that found black women were less likely than white women to stick to a prescription. But that difference went away when they considered financial factors.

If you are on hormonal therapy, or taking other breast cancer medicines taken at home, do your best to follow the instructions of your doctor. If you are having trouble paying for medicine, speak to your healthcare team.

Biggers, A; Shi, Y; Charlson, J; et al. Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy. Journal of Clinical Oncology 34, no. 36 (December 2016); doi: 10.1200/JCO.2016.67.3350