Federal Subsidy Improves Drug Adherence in Breast Cancer

Roxanne Nelson

October 15, 2014

Breast cancer patients who participated in a program that helps pay for medication improved their adherence to hormone therapy, according to a new study.

The Medicare Part D Extra Help program initiated by the federal government provides medication subsidies for patients with limited resources and income. In the study population, the subsidy eliminated or reduced out-of-pocket costs for hormone therapy, which range from about $155 to $428 per year.

In a national sample of more than 20,000 Medicare beneficiaries with breast cancer who were receiving hormone therapy, 27% were enrolled in the subsidy program. Enrollment in the program was particularly high among minorities — 70% of black, 56% of Hispanic, and 21% of white women received support.

For all racial/ethnic groups, adherence to hormonal therapy was substantially better in women enrolled in the program than in those not enrolled, said lead author Alana Biggers, MD, MPH, assistant professor of clinical medicine at the University of Illinois in Chicago.

She spoke during a press briefing held in advance of the Quality Care Symposium 2014, where the study results will be presented.

Table. Adherence to Treatment by Enrollment in the Extra Help Program

Racial/Ethnic Group Subsidized Patients, % Nonsubsidized Patients, %
Black 67 55
Hispanic 71 55
White 71 62


"The Extra Help program holds promise in improving health outcomes and equity by reducing the disparity gap among different races and ethnicities," Dr Biggers said.

Breast cancer outcomes are generally worse in black women than in white women, but the role that income and out-of-pocket costs play in these disparities has not been well studied, she pointed out.

In their retrospective cohort study, Dr Biggers and colleagues assessed differences in adherence to hormone therapy by race/ethnicity, and hypothesized that subsidies might help reduce the disparities. They collected data from a national sample of 23,299 women diagnosed with early-stage breast cancer who were enrolled in Medicare Part D and who were prescribed hormone therapy (tamoxifen, anastrozole, letrozole, or exemestane) in the year after surgery.

During the first year of therapy, the differences in adherence by race were small but statistically significant (63.2% for black, 66.7% for Hispanic, 64.2% for white women). Adherence to therapy declined in years 2 and 3, but the reductions were much smaller in women enrolled in the subsidy program than in those who were not, Dr Biggers explained.

"Over a 2-year period, adherence rates were almost identical, with black and Hispanic women having higher adherence rates than white women," she reported. "But those on the low-income subsidy program had much higher adherence rates than those who were not; this was confirmed in adjusted models."

These data are interesting because they show how this type of program can improve outcomes, said Gregory A. Masters, MD, chair of the American Society of Clinical Oncology Cancer Communications Committee, who moderated the briefing. "This helps us better understand how they support the patient and hopefully improve overall survival," he noted.

"We know that improving adherence is a critical factor in providing the best care for patients," he added.

The study was funded by the American Cancer Society. The authors have disclosed no relevant financial relationships.

Quality Care Symposium 2014: Abstract 2. Presented October 17, 2014.


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