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For High-Risk Women, Some Breast Cancer Drugs To Be Free

WebMD News from Kaiser Health News

By Phil Galewitz

Thu, Jan 09 2014

Starting next September, women at increased risk for breast cancer will be able to get some drugs shown to help prevent the disease without a co-pay, the Obama administration said Thursday.

The U.S. Preventive Services Task Force  recommended last September that clinicians give medications such as tamoxifen or raloxifene to such women to reduce their risk of the disease. Under the Affordable Care Act, items or services rated A or B by the independent review board of physicians and academics must be covered by insurers without a co-pay or deductible. Insurers are given a year to make the change.

A spokesman for the insurance industry noted that while helping breast cancer patients get care is “a top priority for health plans,”  prescription drugs are not “free,” and the costs of those drugs would be reflected in the premiums that all consumers pay for coverage.

In addition, “we are concerned about the precedent of expanding the definition of prevention to now include some treatments that must be covered with no cost-sharing,” said the spokesman, Robert Zirkelbach of America’s Health Insurance Plans (AHIP).

The American Cancer Society Cancer Action Network praised the requirement,  saying it would help more women stay healthy, thereby saving money in the long term.

“This policy means millions of women at high risk for breast cancer will know they can access proven risk-reducing medications at no cost to them,” said spokesman Steve Weiss. “Studies show that even modest cost-sharing can keep patients from taking advantage of proven preventive tests and therapies. By making prevention more accessible and affordable, the health care law is helping people stay healthy and avoid the high costs of treatment after diagnosis.”

A 2010 study  found that about 52,000 women were taking tamoxifen, yet the researchers wrote “in 2000, there would have been some 10 million women in the United States 35 to 79 years of age who were eligible for tamoxifen chemoprevention on the basis of their risk factors … For 2.4 million of these women, it was believed that the benefits of taking tamoxifen outweighed the risks.”

 

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

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