Women Face High Out-of-Pocket Costs for Breast Cancer Treatment

The annual out-of-pocket cost for women with an invasive breast cancer diagnosis receiving insurance coverage through an employer-sponsored plan was $1,502.23, a study published in JAMA Network Open found.

Oral anticancer prescription drugs are crucial to breast cancer treatment, but high out-of-pocket costs may prevent people from accessing medication.

Researchers used data from the national Marative MarketScan database to assess out-of-pocket healthcare costs of invasive breast cancer treatment among women with employer-sponsored health insurance.

Out-of-pocket costs included outpatient, inpatient, and prescription drug costs paid out of pocket.

The study included 25,224 women 18 to 64 years old who were continuously enrolled in a health plan in 2018, had a diagnosis of invasive breast cancer, and had a claim for at least one FDA-approved anticancer drug.

Almost a quarter of women had high deductible health plans or consumer-driven health plans. Just over half of the women had no out-of-pocket drug costs, and 16 women had no out-of-pocket costs for any care modality.

The total mean annual out-of-pocket cost was $1,502.23 per person. Inpatient costs accounted for $112.41, outpatient costs accounted for $1,186.27, and prescription drug expenses accounted for $203.55.

Out-of-pocket expenses for outpatient claims comprised 79 percent of total costs, the study noted. Among drug claims, 87 percent were for nonproprietary drugs, and the mean out-of-pocket cost of filling a 30-day supply of individual drugs ranged from $0.58 to $137.58. Expenses were higher for individuals who used branded or more recently approved drugs.

Researchers also found that women with high deductible health plans and consumer driven health plans had higher out-of-pocket treatment costs than those with preferred provider organization (PPO) and exclusive provider organization (EPO) plans.

“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 [out-of-pocket] costs for commercially insured patients with cancer across care modalities,” the study stated.

These findings are supported by past research, which found that patients with new cancer diagnoses enrolled in high deductible health plans experienced higher out-of-pocket costs than those with traditional insurance plans.

Patients with colorectal cancer in a high deductible health plan paid up to $865 more per month in out-of-pocket costs. Patients with breast cancer paid $860 more per month, patients with lung cancer paid $655 more per month, and patients with other types of cancer paid $292 more per month than those in traditional plans, researchers found.

Nearly 40 percent of Americans said that their deductibles were the primary financial barrier for their out-of-pocket healthcare spending, according to a report from PhRMA. Additionally, adults with high deductible health plans were among those most likely to face difficulties navigating their health insurance benefits.