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November 12, 2014
Generics Increase Adherence 50% for Breast Cancer Hormone Therapy
New York—Why do half of women with hormone receptor–positive tumors fail to adhere to therapy known to substantially reduce their breast cancer recurrence? Unaffordability is one answer to that question, according to a new study.
In fact, the introduction of lower cost generic aromatase inhibitors (AI) increased treatment adherence by 50%, according to the study published online by the Journal of the National Cancer Institute. “Our findings suggest that more effort should be made to reduce out-of-pocket costs for these potentially life-saving medications. This is especially important given the rapid increase of expensive oral cancer therapies,” said lead author Dawn L. Hershman, MD, MS, of the Mailman School of Public Health at Columbia University Medical Center. “We know that hormone therapy for women with hormone receptor–positive breast cancer can reduce recurrence by up to 50%,” said Hershman said. “However, work by our group and others has shown that a substantial number of women discontinue treatment before the recommended five years or do not take the prescribed dose. This is increasingly important because we are starting to learn that even longer therapy—up to 10 years—may be beneficial. It's critical that we understand why people do not take their medication and what we can do to improve adherence.” In a previous study, Hershman and her colleagues found that higher co-payments for aromatase inhibitors (AIs) significantly decreased adherence to therapy. Then, when AIs were released in generic form in 2010, “we had a unique opportunity to study whether a reduction in overall medication cost would make a difference in adherence,” she explained. To determine that, researchers examined the pharmacy records of 5,511 women 50 or older who had early-stage breast cancer requiring lumpectomy or mastectomy and who were prescribed hormonal therapy from 2007 to 2012. More than half, 51.1%, of the patients were on brand name AIs, 25.6% were on generic Ais, and 23% switched from brand name to generic during the 24-month study period. The 30-day copayment averaged about $33 for the brand-name medication compared to about $9 for the generic. In the 24-month study, researchers found that women taking generic AIs were 50% more likely to take the medications on schedule and 30% less likely to discontinue therapy early, compared with women taking brand-name AIs. Of women using brand-name drugs, 33% discontinued therapy, compared with just 16% on generics. As monthly out-of-pocket co-payments increased, adherence rates decreased. In general, higher income was associated with medication adherence. “Even a small increase in monthly co-payments, from less than $15 to $15 to $30, resulted in a significant decrease in adherence," said Hershman. "That might not seem like a lot of money, but it can be a big expense if you multiply it over five or 10 years and you have other prescriptions to pay for.” Hershman pointed out that cost was not the only factor in medication nonadherence—joint stiffness is a common problem with AIs, for example—but can intensify other factors. In addition, the medications don’t have an immediate effect that patients can see, she said, adding, "In contrast, if you have hypertension and you're getting regular blood pressure checks, you can see what happens when you stop taking your medication.” “Higher prescription copayment amount was associated with non-adherence and discontinuation of AIs,” study authors write. “After controlling for copayment, discontinuation was higher and adherence was lower with brand AIs. Because non-adherence is associated with worse survival, efforts should be directed towards reducing out-of-pocket costs for these life-saving medications.” Hershman urged healthcare providers to discuss drug affordability with patients. “Many patients aren't comfortable raising this issue and will just discontinue therapy. By engaging patients in conversation, we may be able to come up with a solution, perhaps by finding less expensive alternatives or by asking pharmaceutical companies to assist patients with co-payments,” she said. Patients also need to be reminded that AIs are effective and helping prevent recurrence of their breast cancer, Hershman added. |
U.S. Pharmacist Social Connect
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