Generics Keep Out-of-Pocket Costs Low for Women with Breast Cancer

The total estimated annual out-of-pocket cost averages around $1,500 per patient for the treatment of invasive breast cancer that has spread to other parts of the body, according to a recent study of employer-insured women published in JAMA Network Open.

Oral anticancer prescription drugs are essential to the management of invasive breast cancer. However, prescription costs and other aspects of care may present a financial burden to those undergoing treatment. With this in mind, a recent study sought to better understand these costs in an under-investigated patient population.

Rena Conti, Ph.D.

“Our study aims to provide an idea of what women who are generally well-insured pay out-of-pocket in a calendar year to treat their diagnosis for metastatic breast cancer,” study coauthor Rena Conti, Ph.D., associate professor at Boston University, told Formulary Watch.

From the Marative MarketScan database, the researchers identified a cohort of 25,224 women aged 18 to 64 years who were diagnosed with invasive breast cancer that had spread to other parts of the body. They then summed the copays, coinsurance, and deductibles for pharmaceutical, inpatient, and outpatient claims to calculate the total out-of-pocket cost of treatment per patient.

The results revealed that the total mean estimated annual out-of-pocket cost was $1,502.23 per patient, with $112.41 in inpatient costs, $1,186.27 in outpatient costs, and $203.55 in pharmaceutical costs. Of drug claim records, 87% were for generic drugs, with the average out-of-pocket cost of a 30-day supply of medication ranging from $0.58 for tamoxifen to $137.58 for Pfizer’s Ibrance (palbociclib).

Patients with high-deductible or consumer-driven health plans had higher out-of-pocket costs than those insured by an exclusive provider organization plan or a preferred provider organization. Overall, out-of-pocket costs were relatively limited in this group, which researchers attributed largely to medication selection.

“Most women in our sample used generic drugs, which are safe, effective, and low-cost,” Conti said. In fact, 51% of the participants in the study paid zero dollars out-of-pocket for oral anticancer medication.

As expected, drug costs were higher in women who were prescribed newer, brand-name medications. While overall costs were low, outpatient costs made up nearly 80% of the total out-of-pocket costs in this sample.

“Ongoing Medicare reform efforts should be supplemented by commercial insurance reform that focuses on lowering outpatient and newer, branded drug out-of-pocket costs,” Conti said.

Regarding the study’s limitations, Conti explained that their results are likely an underestimate as they were not able to measure costs related to complications of treatment. In addition, they were unable to estimate costs by cancer stage or in those 65 and older.

The study was funded by the American Cancer Society.