title: Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy.
abstract: Purpose To investigate the role of out-of-pocket cost supports through the Medicare Part D Low-Income Subsidy on disparities in breast cancer hormonal therapy persistence and adherence by race or ethnicity. Methods A nationwide cohort of women age ≥ 65 years with a breast cancer operation between 2006 and 2007 and at least one prescription filled for oral breast cancer hormonal therapy was identified from all Medicare D enrollees. The association of race or ethnicity with nonpersistence (90 consecutive days with no claims for a hormonal therapy prescription) and nonadherence (medication possession rate < 80%) was examined. Survival analyses were used to account for potential differences in age, comorbidity, or intensity of other treatments. Results Among the 25,111 women in the study sample, 77% of the Hispanic and 70% of the black women received a subsidy compared with 21% of the white women. By 2 years, 69% of black and 70% of Hispanic patients were persistent compared with 61% of white patients. In adjusted analyses, patients in all three unsubsidized race or ethnicity groups had greater discontinuation than subsidized groups (white patients: hazard ratio [HR], 1.83; 95% CI, 1.70 to 1.95; black patients: HR, 2.09; 95% CI, 1.73 to 2.51; Hispanic patients: HR, 3.00; 95% CI, 2.37 to 3.89). Racial or ethnic persistence disparities that were present for unsubsidized patients were not present or reversed among subsidized patients. All three subsidized race or ethnicity groups also had higher adherence than all three unsubsidized groups, although with the smallest difference occurring in black women. Conclusion Receipt of a prescription subsidy was associated with substantially improved persistence to breast cancer hormonal therapy among white, black, and Hispanic women and lack of racial or ethnic disparities in persistence. Given high subsidy enrollment among black and Hispanic women, policies targeted at low-income patients have the potential to also substantially reduce racial and ethnic disparities.
authors.affiliation: Alana Biggers, University of Illinois-Chicago, Chicago, IL; and Yushu Shi, John Charlson, Elizabeth C. Smith, Alicia J. Smallwood, Ann B. Nattinger, Purushottam W. Laud, and Joan M. Neuner, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Alana
authors.initials: A
authors.lastname: Biggers
authors.affiliation: Alana Biggers, University of Illinois-Chicago, Chicago, IL; and Yushu Shi, John Charlson, Elizabeth C. Smith, Alicia J. Smallwood, Ann B. Nattinger, Purushottam W. Laud, and Joan M. Neuner, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Yushu
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Alana Biggers, University of Illinois-Chicago, Chicago, IL; and Yushu Shi, John Charlson, Elizabeth C. Smith, Alicia J. Smallwood, Ann B. Nattinger, Purushottam W. Laud, and Joan M. Neuner, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: John
authors.initials: J
authors.lastname: Charlson
authors.affiliation: Alana Biggers, University of Illinois-Chicago, Chicago, IL; and Yushu Shi, John Charlson, Elizabeth C. Smith, Alicia J. Smallwood, Ann B. Nattinger, Purushottam W. Laud, and Joan M. Neuner, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Smith
authors.affiliation: Alana Biggers, University of Illinois-Chicago, Chicago, IL; and Yushu Shi, John Charlson, Elizabeth C. Smith, Alicia J. Smallwood, Ann B. Nattinger, Purushottam W. Laud, and Joan M. Neuner, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Smallwood
authors.affiliation: Alana Biggers, University of Illinois-Chicago, Chicago, IL; and Yushu Shi, John Charlson, Elizabeth C. Smith, Alicia J. Smallwood, Ann B. Nattinger, Purushottam W. Laud, and Joan M. Neuner, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
authors.affiliation: Alana Biggers, University of Illinois-Chicago, Chicago, IL; and Yushu Shi, John Charlson, Elizabeth C. Smith, Alicia J. Smallwood, Ann B. Nattinger, Purushottam W. Laud, and Joan M. Neuner, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Purushottam W
authors.initials: PW
authors.lastname: Laud
authors.affiliation: Alana Biggers, University of Illinois-Chicago, Chicago, IL; and Yushu Shi, John Charlson, Elizabeth C. Smith, Alicia J. Smallwood, Ann B. Nattinger, Purushottam W. Laud, and Joan M. Neuner, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Neuner
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000191:economics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D054524:Medicare Part D / Q000191:economics* / Q000706:statistics & numerical data; D055118:Medication Adherence / Q000208:ethnology*; D020380:Needs Assessment; D011379:Prognosis; D044469:Racial Groups; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014481:United States
chemical_list: D018931:Antineoplastic Agents, Hormonal