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Prescription subsidies reduce racial disparities in hormone therapy persistence
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Medicare prescription subsidies significantly improved hormone therapy persistence and adherence among low-income black, Hispanic and white women with breast cancer, according to study results.
“Although adjuvant hormonal therapy for hormone-positive breast cancer reduces 15-year mortality by more than one-third, one-third to one-half of patients do not take all doses, substantially reducing treatment effectiveness,” Alana Biggers, MD, MPH, assistant professor of clinical medicine at University of Illinois at Chicago, and colleagues wrote. “Some studies show that nonadherence — defined as the number of doses taken out of the number of doses prescribed — and nonpersistence (early discontinuation) are substantially higher in black women and women with low incomes. Little is known about adherence or persistence among Hispanic women.”
Previous studies demonstrated that a lack of insurance coverage and higher copays for newer treatments are associated with discontinuation or nonadherence. However, little research had been conducted to determine whether interventions that reduce out-of-pocket costs had any effect on disparities.
Researchers selected a cohort of 25,111 women aged 65 years and older from all enrollees in Medicare Part D. All patients underwent breast cancer surgery between 2006 and 2007, and filled at least one prescription for hormone therapy.
Biggers and colleagues analyzed the associations between race/ethnicity and therapy nonadherence or nonpersistence.
Seventy-seven percent of Hispanic women in the study received subsidies, as did 70% of black women and 21% of white women. Researchers reported 69% of black patients, 70% of Hispanic patients and 61% of white patients were persistent with therapy after 2 years.
An adjusted analysis showed patients who did not receive subsidies were more likely than those who did to discontinue treatment. This observation was consistent for white patients (HR = 1.83; 95% CI, 1.7-1.95), black patients (HR = 2.09; 95% CI, 1.73-2.51) and Hispanic patients (HR = 3; 95% CI, 2.37-3.89).
Researchers observed substantial racial disparities in adherence among unsubsidized patients.
Among unsubsidized patients, black women were more likely than white women to discontinue therapy in the first 5 months (HR = 1.31; 95% CI, 1.02-1.68). Similarly, Hispanic women were more likely than white women to discontinue therapy between 5 and 35 months (HR = 1.32; 95% CI, 1.10-1.58).
Researchers did not observe racial or ethnic disparities in therapy persistence among subsidized patients. Among Hispanic women, these disparities reversed between 5 months and 35 months (HR = 0.8; 95% CI, 0.68-0.95).
“Our study supports the potential for policy interventions to improve equity in cancer outcomes,” Biggers and colleagues wrote. “The substantially higher persistence and adherence among women of all three race or ethnicity groups enrolled onto the Medicare D Low-Income Subsidy should lead to further efforts to ensure all eligible women are enrolled.
“Furthermore, legislative and advocacy efforts should focus on lowering out-of-pocket costs for younger women,” they added. “Given the high costs of oral oncologic and supportive medications, the impact on disparities of other initiatives to reduce out-of-pocket costs deserves urgent study.” – by Andy Polhamus
Disclosure: Biggers reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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