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.”
On its website, however, the Society warns that tamoxifen is linked to increased uterine cancers in women over 50.
The White House policy is based on a study called ATLAS that found using the drug for 10 years instead of five slightly reduced overall death rates from breast cancer from 21.1% to 18.6%, the Journal of the American Medical Association reported. However, "long-term tamoxifen use caused more problems with blood clotting, heart attacks, and endometrial cancers."