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Evidence-Based Oncology December 2015
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Managed Care Updates: Oncology
Surabhi Dangi-Garimella, PhD

Managed Care Updates: Oncology

Surabhi Dangi-Garimella, PhD
Updates on screening age recommendations for mammograms, CDC report on a decline in smoking rates in the country, and regulation of laboratory-developed tests.
Lead author Cathy J. Bradley, PhD, said in a press release, “What this research says is that general health insurance isn’t enough. You have to have prescription drug coverage.”1 Bradley is associate director for Population Studies at the CU Cancer Center and professor in the Colorado School of Public Health. “When someone thinks about coverage for high-cost care, they’re usually thinking about that trip to the hospital that costs $80,000 that could leave them bankrupt. But, the fact is that the cost of prescription medicines—even fairly lowcost medications—can also be ‘catastrophic.’”

With President Obama’s renewed attention to precision medicine and provisions of the Affordable Care Act, changes within insurance benefits are imminent. However, there are certain caveats. For example, in addition to being expensive, many of the targeted agents are oral medications to be self-administered at home, as opposed to an infusion that requires a patient to visit the clinic. This can result in adherence issues. Patients can skip doses or not fill a prescription, which can result in poor outcomes.

Pointing out that there’s plenty of evidence showing that if people feel that a drug is too expensive, they stop taking it, Bradley says, “This study suggests that reluctance to insure prescription drugs may result in increased recurrence and poor survival among women with breast cancer, one of the largest groups of cancer survivors.” EBO


1. Without prescription coverage, some cancer patients do without even low-cost drugs [news release]. Denver, CO: EurekAlert!; November 18, 2015. Accessed November 18, 2015.

2. Bradley CJ, Dahman B, Jagsi R, Katz S, Hawley S. Prescription drug coverage: implications for hormonal therapy adherence in women diagnosed with breast cancer. Breast Cancer Res Treat. 2015;154(2):417-422.

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