The impact of state parity laws on copayments for and adherence to oral endocrine therapy for breast cancer

Abstract

Background Adherence to endocrine therapy for breast cancer is often inadequate, in part because of out‐of‐pocket costs for medication. Numerous states have enacted parity laws to limit patient cost‐sharing for oral anticancer drugs. The objective of this study was to estimate the impact of these laws on patient copayments for and adherence to oral endocrine therapy for breast cancer. Methods Administrative health insurance claims data from 2007 to 2014 derived from a US health care database were used to identify female patients aged 18 to 64 years with invasive cancer or ductal carcinoma in situ of the breast who initiated endocrine therapy and were enrolled in fully insured health plans in states that either enacted parity legislation between 2008 and 2013 or had not yet enacted such legislation by 2015. Differences‐in‐differences analysis was used to compare copayments for and adherence to endocrine therapy during the 1‐year period before and after each year of legislation enactment. Results In total, 6900 individuals who received 7778 unique drug therapy courses were identified. Parity legislation was associated with significant decreases in the 25th percentile of copayments for anastrozole of $4.39 (95% confidence interval [CI], −$4.52 to −$4.26; P < .001) and for exemestane of $3.08 (95% CI, −$4.80 to −$1.35; P < .001). The median copayment for exemestane decreased by $10.25 (95% CI, −$12.61 to −$7.89; P < .001). A higher median monthly copayment was significantly associated with a greater risk of medication nonadherence (adjusted risk ratio, 1.006 per dollar increase; P < .001). Conclusions Parity laws had a modest effect on lowering the cost of anastrozole and exemestane, but more focused efforts to limit out‐of‐pocket costs for endocrine therapy may have a greater impact on medication adherence.

More evidence on the limited impact of state oral oncology parity laws

“…In the current issue of Cancer, Chin and colleagues provide an evaluation of how parity has impacted out-of-pocket spending on endocrine therapy for the prevention of breast cancer recurrences, comparing states with and without oral oncology parity laws between 2007 and 2014. 1 Consistent with prior work, their study indicates that oral oncology parity laws did not consistently reduce out-of-pocket spending for endocrine therapy. 2 Indeed, parity reduced spending at the 25th percentile of spending for 2 drugs (anastrozole and exemestane), increased it for a third drug (letrozole), and had no effect on the fourth drug (tamoxifen).…”

“…In the current issue of Cancer , Chin and colleagues provide an evaluation of how parity has impacted out‐of‐pocket spending on endocrine therapy for the prevention of breast cancer recurrences, comparing states with and without oral oncology parity laws between 2007 and 2014 . Consistent with prior work, their study indicates that oral oncology parity laws did not consistently reduce out‐of‐pocket spending for endocrine therapy .…”

The Out-of-Pocket Cost Burden of Cancer Care—A Systematic Literature Review

“…The systematic review identified 3639 records, of which 105 full-text studies were retrieved [ 8 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ,…”

Breast cancer patients' insurance status and residence zip code correlate with early discontinuation of endocrine therapy: An analysis of the ECOG‐ACRIN TAILORx trial

“…Additional efforts should be made to implement initiatives such as price transparency, insurance optimization, and financial navigation to mitigate the patient‐borne effects of cost sharing 45‐47 . Enactment of parity laws and efforts to limit ET out‐of‐pocket costs may also affect medication adherence 48 . Additional efforts such as coordination of transportation for clinic visits and use of telemedicine and personalized culturally tailored interventions may improve early discontinuation due to limited access to health care.…”