The U.S. Preventive Services Task Force聽 recommended聽last September that clinicians give聽medications such as tamoxifen or raloxifene聽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. to make the change.
A聽spokesman for聽the insurance industry noted that while helping breast cancer patients聽get care is “a top priority for health plans,”聽聽prescription drugs are not “free,” and the costs聽of those drugs would be聽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聽Insurance Plans (AHIP).
The American Cancer Society Cancer Action Network praised the聽requirement,聽 saying it聽would聽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.”
础听2010 聽聽found that about 52,000 women were taking tamoxifen, yet the researchers wrote “in 2000, there would have been some 10聽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聽million of these women, it was believed that the benefits of taking tamoxifen outweighed the risks.”
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