Medicare Part D Subsidy Improves Outcomes, Reduces Racial Disparities in Women With Breast Cancer

Alana Biggers, MD, MPH

Even though breast cancer predominantly affects white women, breast cancer outcomes are worse among black women. But a new study suggests that enrollment in a federal program may help reduce racial disparities among these patients.

Results of a large study suggest the Medicare Part D Extra Help program, which provides low-income subsidies (LIS) for medications, improves women’s adherence to hormone therapy after breast cancer surgery in all racial/ethnic groups while reducing racial/ethnic disparities.

The results of this study were presented during a press briefing today in advance of the American Society of Clinical Oncology's (ASCO) 2014 Quality Care Symposium, which takes place October 17-18, 2014.

“Patients involved in the Extra Help program had substantially higher adherence rates for hormonal breast cancer therapy when compared with women who did not receive the LIS, even when stratified by race and ethnicity,” said Alana Biggers, MD, MPH, a former internal medicine resident at the Medical College of Wisconsin in Milwaukee, and currently an assistant professor of clinical medicine at the University of Illinois-Chicago.

Black women are more likely to die from breast cancer than any other group. In addition, low socioeconomic status increases death rates regardless of race or ethnicity. Factors that add to the disparity include poor or limited access to healthcare, inadequate early screening and detection, lack of health insurance, and genetics—black women more often carry inherited mutations that predispose them to breast cancer.

Researchers collected data from 23,299 women enrolled in Medicare D who were diagnosed with breast cancer and who underwent mastectomy or breast-conserving surgery between 2006 and 2007, as well as received either tamoxifen or an aromatase inhibitor (anastrazole, letrozole, or exemestane) within 1 year of surgery. Nonadherence rates were calculated by race and low-income subsidy status for each year after the first prescription was filled through December 2011.

“Adherence to therapy is a critical factor in providing the best quality of care to patients,” said Greg A. Masters, MD, moderator of the briefing and chair of ASCO's Cancer Communication Committee. “Government programs, like Extra Help, can improve the care in underserved populations,” he said.

The researchers reported that 27% of the women were enrolled in the Extra Help program, which eliminated or reduced out-of-pocket (OOP) costs for hormone therapy. The OOP costs ranged from $155 to $428/year on average. A breakdown by race showed that 21% of white women, 70% of black women, and 57% of Hispanic women received the LIS.

In the first year of hormone therapy, overall adherence rates were similar for white women, black women, and Hispanic women, with rates of 64%, 63%, and 67%, respectively. Among women not enrolled in the Extra Help program, white women had significantly higher adherence rates at 62%, compared with black and Hispanic women (both at 55%).

Receiving the low-income subsidy also resulted in higher adherence rates across racial/ethnic groups, compared with those who did not receive the subsidy (71% vs 62% for white women, 67% vs 55% for black women, and 71% vs 55% for Hispanic women).

In addition, although hormone therapy adherence rates declined in years 2 and 3, adherence rate reductions were smaller among those who participated in the Extra Help program, and this trend was observed in all racial/ethnic groups.

“It's the LIS benefit that's contributing to a higher adherence rate for hormonal therapy,” said Biggers. “The Extra Help program holds promise in improving health equity and outcomes by reducing the disparity gap between different races and ethnicities,” she said.

Reference

Biggers A, Charlson J, Pezzin L, Laud P, Smith E, Smallwood A, et al. Medicare Part D Extra Help program and disparities in breast cancer treatment. Presented at ASCO's Quality Care Symposium. October 17-18, 2014.