Breast Cancer, Financial Toxicity, and the Role of Specialty Pharmacy in Reducing Barriers to Care
As health care costs rise and cost-sharing increases, treatment-associated expenses will continue to burden patients.
This year, an estimated 284,200 women will receive a diagnosis of breast cancer.1 These women will face substantial physical and emotional challenges as they navigate a difficult diagnosis. Patients with breast cancer are also increasingly challenged with significant and persistent financial burden on the road to recovery.
Causes of Health Care Cost Burdens
Financial toxicity caused by the medical and nonmedical costs of breast cancer treatment are negatively impacting women and their clinical outcomes.2 Rising health care costs and shifts in cost-sharing are contributing to financial toxicity experienced by patients with cancer. New cancer therapies are providing hope and driving better clinical outcomes but also significantly increasing the overall cost of care.3 Seven percent of all health care spending is associated with cancer, and cancer tops the list of the most costly health conditions in terms of personal expenditures.4
The cost of breast cancer treatment varies by age and phase of care, ranging from $20,000 to $100,000 or more.5 Overall health care costs are increasing as health insurance companies are shifting additional financial responsibility to the patient. From 2006 to 2016, the average health insurance deductible increased from $300 to over $1200, and health insurance cost-sharing often outpaces wage growth.6 As health care costs rise and cost-sharing increases, financial toxicity will continue to burden patients with breast cancer.
Furthermore, financial challenges are impacting health care access for women without a breast cancer diagnosis, and the impact of COVID-19 has accelerated these issues. During the pandemic— between February 2020 and January 2021—2.5 million women left the United States workforce, compared with 1.8 million men for the same period.7 Many women who continued to work reported reducing their hours or taking unpaid leave because of increased child care demands brought on by school and day care closures.8 Additionally, women are forgoing essential health care services, and skipping tests, treatments, and preventive care appointments at a higher rate than men.9
A recent study found that financial barriers are impeding women at high risk for breast cancer from accessing preventive screenings and other measures, despite having insurance coverage.10 Women who did seek health care services reported challenges paying their medical bills.11
Prevalence of Financial Toxicity for Patients With Breast Cancer
Nearly half of women who receive a breast cancer diagnosis will experience some level of financial toxicity, which occurs disproportionately among minority populations.12 Current literature suggests women may not be receiving enough counseling and support from their medical providers to adequately address the issue of financial toxicity. One study indicated that only 28% of clinicians felt comfortable discussing finances and out-of-pocket (OOP) costs with their patients.13
In a recent survey of patients with breast cancer, 72.8% of 945 respondents felt they did not receive help, at least somewhat, around issues of financial toxicity from their physician or their physician’s staff. In the same study, over half of respondents who expressed wanting to speak to health care providers about the impact of their diagnosis on their employment or finances reported no relevant discussion with their clinical team.14
Pharmacists’ Role in Mitigating Payment Issues
Specialty pharmacies are uniquely positioned to help patients with breast cancer address issues of financial toxicity. Intake staff regularly interface with patients, prescribers, payers, and pharmaceutical manufacturers. Acting as an intermediary between these parties, the intake team plays a critical role advocating for treatment access and helping reduce financial toxicity. One-on-one consultations help patients understand their OOP costs and identify strategies to minimize financial burden. The intake team often enrolls the patient in manufacturer assistance co-pay programs while providing referrals to charitable organizations assisting with the nonmedical costs associated with cancer care.
According to Lydia Ezekiel, a referral specialist for a national specialty pharmacy, specialty pharmacies play a role in helping patients with breast cancer overcome financial toxicity.
“Our goal is to work within available and appropriate resources to achieve a $0 co-pay,” Ezekiel said. “We delight in informing our patients they will receive their medication at no cost. We also help patients identify resources assisting with transportation, food, or other nonmedical needs.”
Ezekiel also noted that by obtaining patient consent, the team can do extensive research and outreach on the patient’s behalf, referring to charitable organizations without burdening patients with an additional task. However, with so many women in need, a growing number of charities are forced to put patients on waiting lists.
“Many patients meet eligibility criteria for grants but are wait-listed by the foundation due to lack
of funds,” said Ezekiel. “We don’t let that slow us down, though. By the time we exhaust all available options, we’ve usually secured some level of support alleviating at least a portion of the financial burden patients are facing.”
Amanda Hasenei is a certified pharmacy technician and referral specialist who has spent over a decade working in the specialty pharmacy space. She said it is not uncommon for patients with breast cancer she sees to be completely overwhelmed with the financial aspects of their care.
“Our first priority is to acknowledge their concerns and assure them they are not alone in the process. We establish goals and priorities around the most immediate financial concerns and then we work relentlessly to overcome them,” said Hasenei.
Strong clinical coordination can also help alleviate financial toxicity. Pharmacists help patients understand their treatment and avoid complications that can result in hospitalization or missed work. One study found a singular oncology specialty pharmacist provided interventions with an estimated annual value of nearly $1 million.15 The most frequent interventions included medication education, dose adjustments, and medication reconciliation.
Kionna Oleru is a specialty pharmacist who has spent a significant amount of her career serving women with breast cancer. She described the role of a specialty pharmacist in reducing financial toxicity for patients through clinical support.
“Adherence management, validated assessments, and clinical follow-up helps to improve health while decreasing likelihood of delaying or discontinuing treatment. Working together to clinically improve health and make therapy more manageable means less missed work, fewer hospitalizations or doctor appointments, and fewer changes in therapy,” said Oleru.
Women with breast cancer are facing unique financial challenges wrought by rising health care costs, increased cost-sharing, and challenges associated with the pandemic. Research indicates many of these women may not be receiving enough support around the financial impact of their cancer treatment.
Specialty pharmacies have proven their ability to positively impact outcomes for oncology patients, including financial toxicity. Coordinating support across a range of resources and stakeholders, specialty pharmacies are helping alleviate financial toxicity and lighten the burden for patients with breast cancer so they can focus on achieving better health.
Justin Linhorst, MBA, is a marketing director and regional care coordinator for BioMatrix Specialty Pharmacy in Fort Lauderdale, Florida.
- Breast Cancer Statistics. American Cancer Society. 2021. Accessed July 7, 2021. https://cancerstatisticscenter.cancer.org/?_ga=2.187180392.1302374579.1619634311-1366161058.1619634311#!/ cancer-site/Breast
- Cannon S, Simon D. Removing the barriers to care for breast cancer patients: Improving timeliness to care. J Oncol Navig Surviv. 2020;11(12). Accessed July 7, 2021. https://www.jons-online.com/issues/2020/december-2020-vol-11-no-12/3262-removing-the-barriers-to-care-for-breast-cancer-patients-improving-timeliness-to-care
- Wilson LE, Greiner MA, Altomare I, Rotter J, Dinan MA. Rapid rise in the cost of targeted cancer therapies for Medicare patients with solid tumors from 2006 to 2015. J Geriatr Oncol. 2020;12(3):375-380. doi:10.1016/j.jgo.2020.11.007
- Laviana AA, Luckenbaugh AN, Resnick MJ. Trends in the cost of cancer care: beyond drugs. J Clin Oncol. 2020;38(4):316-322. doi:10.1200/JCO.19.01963
- Trogdon JG, Baggett CD, Gogate A, et al. Medical costs associated with metastatic breast cancer in younger, midlife, and older women. Breast Cancer Res Treat. 2020;181(3):653-665. doi:10.1007/s10549-020-05654-x
- Claxton G, Levitt L, Rae M, Sawyer B. Increases in cost-sharing payments
continue to outpace wage growth. Peterson KFF Health System Tracker. June
15, 2018. Accessed July 7, 2021. https://www.healthsystemtracker.org/brief/ increases-in-cost-sharing-payments-have-far-outpaced-wage-growth/
- Marte J, Michalska A. Pushed out by pandemic, women struggle to regain footing
in U.S. job market. Reuters. Updated March 5, 2021. Accessed July 7, 2021. https:// www.reuters.com/article/us-health-coronavirus-women-jobs/pushed-out-by-pandemic-women-struggle-to-regain-footing-in-u-s-job-market-idUSKBN2AW19Y
- Bolido, L. COVID-19 takes heavy toll on working women. Inquirer.net.
April 26, 2021. Accessed July 7, 2021. https://business.inquirer.net/321657/ covid-19-takes-heavy-toll-on-working-women
- Frederiksen B, Ranji U, Slganicoff A. Women’s experiences with health care during the COVID-19 pandemic: findings from the KFF women’s health survey. Kaiser Family Foundation. March 22, 2021. Accessed July 7, 2021. https://www.kff.org/womens-health-policy/issue-brief/womens-experiences-with-health-care-during-the-covid-19-pandemic-findings-from-the-kff-womens-health-survey/
- Henderson E. Study: women at high risk of breast cancer face financial barriers to care. News Medical Life Sciences. April 21, 2021. Accessed July 7, 2021. https://www. news-medical.net/news/20210421/Study-Women-at-high-risk-of-breast-cancer-face-financial-barriers-to-care.aspx
- D’Ambrosio, A. 2020 was a lost year for women’s medical care. Medpage Today. April 22, 2021. Accessed July 7, 2021. https://www.medpagetoday.com/special-reports/exclusives/92223
- Many young women have financial problems after breast cancer diagnosis,
even with insurance. Breastcancer.org. March 20, 2020. Accessed July 7, 2021. https://www.breastcancer.org/research-news/financial-problems-after-dx-despite-insurance#:~:text=The%20results%3A%20Nearly%20half%20had,17%25%20spent%20 %245%2C001%E2%80%93%2410%2C000
- Carrera PM, Kantarjian HM, Blinder VS. The financial burden and distress of patients with cancer: Understanding and stepping‐up action on the financial toxicity of cancer treatment. CA Cancer J Clin. 2018;68(2):153-165. doi:10.3322/caac.21443
- National Cancer Institute. Financial toxicity and cancer treatment. Updated June
21, 2021. Accessed July 7, 2021. https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-hp-pdq
- Virani A, Schlei Z, Gleason C, et al. Impact of an oncology clinical pharmacist specialist in an outpatient multiple myeloma clinic. Clin Lymphoma Myeloma Leuk. 2020;20(9) e543-560. doi:10.1016/j.clml.2020.04.012