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Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy. J Clin Oncol 2016 12 20;34(36):4398-4404 PMID: 27998232 PMCID: PMC5455308

Pubmed ID



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.

Author List

Biggers A, Shi Y, Charlson J, Smith EC, Smallwood AJ, Nattinger AB, Laud PW, Neuner JM


John A. Charlson MD Associate Professor in the Medicine department at Medical College of Wisconsin
Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Joan Neuner MD, MPH Associate Professor in the Medicine department at Medical College of Wisconsin


2-s2.0-85009740911   8 Citations

MESH terms used to index this publication - Major topics in bold

African Americans
Age Factors
Aged, 80 and over
Antineoplastic Agents, Hormonal
Breast Neoplasms
Cohort Studies
Continental Population Groups
Healthcare Disparities
Hispanic Americans
Kaplan-Meier Estimate
Medicare Part D
Medication Adherence
Needs Assessment
Retrospective Studies
Statistics, Nonparametric
Survival Analysis
United States
jenkins-FCD Prod-321 98992d628744e349846c2f62ac68f241d7e1ea70