Employer-Insured Women With Invasive Breast Cancer Paid Limited Out-of-Pocket Treatment Costs

More than half of younger patients with invasive breast cancer that has spread to other parts of the body and who have employee-sponsored insurance did not pay out-of-pocket (OOP) costs for oral anticancer drugs, according to research recently published in JAMA Network Open.

Among patient subgroups, patients with high-deductible health plans (HDHPs) and consumer-driven health plans (CDHPs) paid more than patients insured by a preferred provider organization or have an exclusive provider organization plan, according to the study authors.

High OOP costs are linked to the discontinuation and treatment nonadherence of oral anticancer prescription drugs for breast cancer. Young women under 65 years of age with invasive breast cancer could be at increased burden because of finances that include long-term hormonal-based prevention and HDHP and/or CDHP plans, according to the researchers. The investigators conducted the cross-sectional study to evaluate their OOP costs for invasive breast cancer treatment.

Using the Marative MarketScan database, they identified a cohort of 25,224 patients aged 18 to 64 years who were diagnosed with invasive breast cancer. The patients were employer-insured in 2018 and granted a claim for 1 FDA-approved anticancer drug by their insurer.

The team calculated total cost—including co-payments, coinsurance, and deductibles for pharmaceutical, inpatient, and outpatient claims—and mean estimated annual OOP cost for filling a drug, standardized to represent a 30-day supply.

At least 23.1% of patients had a HDHP or CDHP and 51.0% did not pay any OOP treatment costs. Among participants, 16 women did not have to pay any OOP costs for any step of the care process.

Per patient, total mean estimated annual OOP cost was $1502.23. Within the total mean cost:

• Outpatient cost was $1186.27.
• Inpatient cost was $112.41.
• Pharmaceutical cost was $203.55.

The average outpatient drug claim accounted for 79.0% of total costs. Additionally, mean cost of a 30-day drug supply ranged from $0.58 to $137.58, depending on the drug.

Further analysis suggests that drug costs were significantly associated with the year in which the FDA approved the drug. Treatments that were more recently approved appear to cost more, on average, than treatments that have been available for longer. Branded drugs followed a similar trend.

“Outpatient-related OOP costs were larger than drug costs, and OOP costs were higher among those using branded or more recently launched drugs,” the study authors wrote in the analysis. Nevertheless, most patients used nonproprietary drugs.

The study includes some limitations. First, investigators underestimated OOP costs because they did not account for costs related to comorbidity treatment and treatment-related complications. Additionally, the patient population did not include women aged 65 years and older.

“Recently passed federal policies seeking to reduce prescription drug prices among Medicare-insured patients could be complemented by voluntary employer or insurer efforts and state legislation to reduce OOP costs for commercially insured patients with cancer across care modalities,” the study authors wrote.

Reference

Hagar A, Gracia G, Rodin D, et al. Out-of-Pocket Costs of Treatment Among Employer-Insured Women With Invasive Breast Cancer. Accessed March 8, 2023. JAMA Netw Open. 2023;6(3):e231507. doi:10.1001/jamanetworkopen.2023.1507