Not everyone chooses to have health insurance coverage that pays some of the cost of prescription medication.
While health insurance policies sold in the Affordable Care Act (ACA) marketplace are required to have some drug coverage, it's still an option for those on Medicare.
Is it coverage you should have? A new study suggests the answer is yes, if you think you are at risk of getting cancer.
General coverage not enough
“I think what this research says is that general health insurance isn’t enough. You have to have prescription drug coverage,” said Cathy J. Bradley, the paper’s first author.
There have been two recent and important changes to cancer treatment: the development of new, targeted treatments for cancer, which tend to be very expensive and also tend to be taken orally and in patients’ homes, and the ACA, which has increased access to health insurance.
“Targeted cancer therapies tend to come in the form of pills taken at home. Many of these new therapies are expensive,” Bradley said. “This combination of more expensive medicines taken outside the hospital setting means less compliance. Or we see people choosing to alter their prescribed regimens by skipping doses. When you start to dial back from recommended doses, at some point the drug loses its effectiveness.”
The Colorado study looked specifically at women treated for breast cancer. Women with household income below $40,000 were less than half as likely as women with annual household income greater than $70,000 to continue hormonal therapy.
Hormonal therapy for patients with estrogen, or progesterone-positive breast cancers can reduce the risk of cancer recurrence by as much as 50%.
Bradley says the rising costs of cancer care is a reason for insurers and healthcare consumers to rethink the definition of “catastrophic” illness. She concludes that women without prescription drug coverage, especially if they are from low-income households, may choose not to comply even with a relatively low-cost treatment regimen.
It's not just an extended stay in a hospital that can bankrupt you, Bradley says. So can relatively “low cost” cancer medications.