Monday, January 27, 2014

ACA Now Covers Breast Cancer Prevention Drugs for High-Risk Women

By Debra Patt, MD, MPH
Austin Oncologist

Editor’s Note: To help in the fight against cancer, the Department of Health and Human Services issued guidance to clarify that under the Affordable Care Act, most health insurance companies and employer plans must cover the cancer-preventing medicines tamoxifen and raloxifene — like other recommended preventive services — without copays or other out-of-pocket expenses for women at increased risk for breast cancer.

Cancer rivals heart disease as the No. 1 preventable cause of death in the United States. Cancer prevention is a team effort and can come in many forms. Sometimes behaviors will reduce risk before cancer has developed. Sometimes early detection catches the disease when an individual shows no symptoms. Sometimes detecting cancer at an earlier state diminishes or delays the effects of the disease.

We know good health choices, such as maintaining a healthy body weight and exercising, sometimes can prevent common cancers. Screening for early detection also can be important in finding cancer before it spreads and causes disease or requires aggressive treatment. Additionally, sometimes chemoprevention is important in reducing the risk of cancer. Chemoprevention is the use of medicine, vitamins, or other substances to prevent or delay the development of cancer.

Several chemoprevention medicines have been shown to reduce the risk of breast cancer by about 50 percent and can be useful in patients at higher risk of developing the disease. I follow many patients like this in my clinic. Tamoxifen and raloxifene (Evista) have been the only medicines used in chemoprevention of breast cancer for some time, but at the 2013 San Antonio Breast Cancer Symposium, evidence from the IBIS-II trial suggested that another chemoprevention medicine, anastrozole (Arimidex), also is effective at chemoprevention among post-menopausal women, and may be less toxic.

Despite the increasing number of chemoprevention options for patients at risk, coverage determinations by insurance companies can be a barrier to the medication patients need to reduce their risk of developing cancer. Often insurance does not cover preventive services, and patients at risk cannot afford indicated treatments. Hopefully, the new requirement for insurers to cover tamoxifen and raloxifene as preventive services will be a good step towards ensuring chemoprevention options for at-risk patients. However, as with any service, patients will still want to check with their carrier to confirm coverage.

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