- Improving access to Medicare Part D subsidies and lowering out-of-pocket patient drug costs can help raise medication adherence rates in patients of low socioeconomic status, according to a new study published in the Journal of Clinical Oncology.
The study focused on women with breast cancer taking oral hormone treatments. According to the research team, breast cancer patients from different racial demographics and lower socioeconomic status tend to have lower medication adherence and higher mortality rates, likely due to the extremely high cost of these drugs.
“Although adjuvant hormonal therapy for hormone-positive breast cancer reduces 15-year mortality by more than one third, one third to one half of patients do not take all doses, substantially reducing treatment effectiveness,” the research team said.
“Some studies show that non-adherence (defined as the number of doses taken out of the number of doses prescribed) and non-persistence (early discontinuation) are substantially higher in black women and women with low incomes.”
Access to Medicare Part D subsidies can improve this phenomenon, according to the researchers.
The team looked at medication non-adherence and non-persistence in 25,111 women over 65 who had recently undergone a breast cancer surgery, were on an oral hormone treatment, and who received Medicare Part D benefits.
Seventy percent of the black women included in the study received the Medicare Part D subsidy, as did 77 percent of Hispanic patients and 21 percent of white patients.
After two years, the researchers saw that the Medicare Part D subsidy reduced medication non-adherence and non-persistence in all race demographics. Sixty-nine percent of black patients, 70 percent of Hispanic patients, and 61 percent of white patients had reached medication persistence by that point.
By study’s end, patients receiving the Medicare Part D subsidy had better medication persistence and adherence than patients not receiving the subsidy. This difference is likely due to the resulting differences in out-of-pocket patient drug costs. Unsubsidized patients faced drug costs between $106 and $183, while the average drug cost for subsidized patients was $10.
High treatment costs may have prohibited unsubsidized patients from seeking treatment, a common financial strategy for many cancer patients, the researchers said. Although a patient may not have a low enough income to qualify for the Medicare Part D subsidy, they can still face financial barriers to taking their medications as needed.
While past research has found patterns in high out-of-pocket patient drug costs and medication non-adherence and non-persistence, the researchers said their current findings about race demographics are novel. Few studies have shown that drug premium subsidies can improve medication usage regardless of race.
“These findings suggest that income- and net worth–based subsidies can benefit patients of all races or ethnicities at least equally and may even benefit non-white (particularly Hispanic) women more,” the research team said.
These findings also have considerable policy implications, suggesting that policymakers must better support Medicare Part D subsidies.
“Our study supports the potential for policy interventions to improve equity in cancer outcomes,” the researchers said. “The substantially higher persistence and adherence among women of all three race or ethnicity groups enrolled onto the Medicare D Low-Income Subsidy should lead to further efforts to ensure all eligible women are enrolled.”
Additionally, these findings suggest that policymakers should continue to fight against high drug prices, ensuring that patients of all socioeconomic statuses can manage their out-of-pocket drug costs and access their medications as directed.
“Legislative and advocacy efforts should focus on lowering out-of-pocket costs,” the researchers concluded. “Given the high costs of oral oncologic and supportive medications, the impact on disparities of other initiatives to reduce out-of-pocket costs deserves urgent study.”