Short Takes On News & Events

For High-Risk Women, Some Breast Cancer Drugs To Be Free

By Phil Galewitz

January 9th, 2014, 3:14 PM

Starting next September, women at increased risk for breast cancer will be able to get some drugs shown to help prevent the disease without a co-pay, the Obama administration said Thursday.

The U.S. Preventive Services Task Force  recommended last September that clinicians give medications such as tamoxifen or raloxifene to such women to reduce their risk of the disease. Under the Affordable Care Act, items or services rated A or B by the independent review board of physicians and academics must be covered by insurers without a co-pay or deductible. Insurers are given a year to make the change.

A spokesman for the insurance industry noted that while helping breast cancer patients get care is “a top priority for health plans,”  prescription drugs are not “free,” and the costs of those drugs would be reflected in the premiums that all consumers pay for coverage.

In addition, “we are concerned about the precedent of expanding the definition of prevention to now include some treatments that must be covered with no cost-sharing,” said the spokesman, Robert Zirkelbach of America’s Health Insurance Plans (AHIP).

The American Cancer Society Cancer Action Network praised the requirement,  saying it would help more women stay healthy, thereby saving money in the long term.

“This policy means millions of women at high risk for breast cancer will know they can access proven risk-reducing medications at no cost to them,” said spokesman Steve Weiss. “Studies show that even modest cost-sharing can keep patients from taking advantage of proven preventive tests and therapies. By making prevention more accessible and affordable, the health care law is helping people stay healthy and avoid the high costs of treatment after diagnosis.”

A 2010 study  found that about 52,000 women were taking tamoxifen, yet the researchers wrote “in 2000, there would have been some 10 million women in the United States 35 to 79 years of age who were eligible for tamoxifen chemoprevention on the basis of their risk factors … For 2.4 million of these women, it was believed that the benefits of taking tamoxifen outweighed the risks.”


5 Responses to “For High-Risk Women, Some Breast Cancer Drugs To Be Free”

  1. Ray says:

    There’s two drugs on the market, one made by the country’s biggest lobbier (Eli Lilly, also Obama’s biggest contributor), and the other made by AstraZeneca, one of the other biggest lobbiers.

    Drugs are both proven to cause bloodclots, strokes, increase the chances of other types of cancer (like uterine) and myriad other side effects, with the tradeoff of “reducing” the chances of getting something most of these “at risk” women will never get (“at risk” means a 5% chance of developing cancer in the next 5 years, these drugs are prescribed for 5 year treatments).

    Cancer is scary, everyone eligible will want this “free” drug. 95% of them never needed it, and of the 5% that do, it’s a reduction of risk, not an elimination. 100% of them, however, are now facing life threatening side effects.

  2. Janet says:

    I am an 11 year suvivor & in the high risk category. Without the combination of Chemo , Tamoxafin & Arimidex I would not be here today.
    My Blue Cross Blue Shield plan paid for those drugs. Thank goodness I had great insurance in the first place.
    Please make these drugs to other high risk women with or without insruance. It is about
    saving lives, not the bottom line.

  3. Donna says:

    I am a 6 1/2 year survivor of breast cancer. My cancer was non-aggressive, though I had multiple tumors in one breast and one tiny one in the other. I opted for a bilateral mastectomy to just get the cancer out. Chemo would have only given me a 2% benefit to avoid a recurrence and radiation was not warranted. So instead I took Tamoxifen for 5 years which, I’m told, gives me 10-15 years of benefit to reduce a risk of recurrence. Now in menopause, they have me on Femara, which has half the side effects of Tamoxifen, they explained. Though I’ve never been a smoker or drinker, and a good candidate, I had two simultaneous blood clots 2 years after taking Tamoxifen. Every other scenario for why I had those two pulmonary embolisms were ruled out, but Tamoxifen. I am very lucky to be alive, but will be taking blood thinners and wearing compression knee-hi’s for the rest of my life. Just know there are risks with these drugs. (BTW, the blood clots occurred as I was climbing into bed…they felt like a rubber band snapped inside my chest.)

  4. K says:

    It sounds like what we need is greater education on the side-effects of risk reducing drugs. I didn’t know that they could be so potentially harmful. I think there’s currently a push to have pharmacists play a greater role in total patient wellness, which would include education, a small amount of counseling, and more back-and-forth engagement between patient and pharmacist throughout a given course of treatment (for example, I know certain health groups are implementing text message correspondence between patient and pharmacist, so the patient can alert pharmacists to any unusual side-effects they are experiencing). Hopefully these initiatives might help weed out individuals who’d otherwise take risk-reducing drugs wihtout knowing the full list of potential side-effects.

  5. It sound like very good..but really they will get benefit ….In countries like USA, UK or other developed countries medicine available very easily but in poor countries and underdeveloped countries where one medicine cost goes up to high. They are not able to pay for her treatment cost to hospital…We are cancer hospital in India trying to make awareness and provide better facility for patient…where India is growing medical hub for other countries..many patient come to India for treatment…and we must to share better knowledge and support to our all patient.

    Thank you