Higher co-pays increase possibility of early discontinuation, inadequate use of breast cancer therapy

A higher prescription co-payment, especially among older women, is associated with the early discontinuation and incomplete use of adjuvant aromatase inhibitor therapy, a life-saving therapy for women with hormone-sensitive, early-stage breast cancer, research shows.

Researchers led by Dawn L. Hershman, MD, associate professor of medicine and epidemiology and co-director of the Breast Cancer Program at the Herbert Irving Comprehensive Cancer Center at Columbia University (New York), examined the impact of prescription co-payments on hormone therapy use. Working with the Medco Research Institute, a wholly owned subsidiary of Medco Health Solutions Inc., anonymous patient information was used to target women older than 50 years who were prescribed aromatase inhibitors for early breast cancer. Two factors were examined: women who discontinued use altogether or had no subsequent refills, and those that did not refill their prescription on time or did not take the medication at least 80% of the time.

Results showed that of the 8,110 women aged 50 to 65 years, 21.1% stopped taking the medication, and of those who properly continued with their regimen, 10.3% did not take the medication as directed over the two-year period. Of the 14,050 women 65 years or older, nearly 25% stopped taking the medication, and of those who continued, 8.9% were non-adherent.

Co-payments were categorized as less than $30, between $30 and $89.99, and $90 or more. The 90-day co-payments ranged from $0 to $893.49.

“This is something you think is the case, but it is hard to prove that it is the case,” Dr. Hershman said. “The research confirms that co-payments can have a big impact on adherence. Even with insurance, patients still have a hard time getting the medication.”