The U.S. Department of Health and Human Services is adding breast cancer prevention to the basic women’s health preventive services package.
The Patient Protection and Affordable Care Act requires non-grandfathered major medical carriers and group health plans to cover the package of services without imposing deductibles, co-payments, coinsurance amounts or other cost-sharing requirements on the patients.
The PPACA preventive services package mandate applies to self-insured group health plans as well as to traditional plans.
HHS Secretary Kathleen Sebelius said today in a blog entry that HHS had already posted breast cancer prevention drug guidance. At press time, the guidance hadn’t appeared.
The breast cancer prevention drug mandate will include coverage for tamoxifen or raloxifene for women who appear to be at high risk for developing breast cancer.
Sebelius added the mandate based on a recommendation from a panel at the U.S. Preventive Services Task Force.
In September, the task force published a recommendation giving use of the cancer prevention drugs a B for women at high-risk of developing cancer. For other women, the task force gave use of the drugs a grade of just D.
A grade of B means that “there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”
The task force says women at high risk are women who seem to have at least a 3 percent risk of developing breast cancer in the next five years.
But the task force recommends against giving two well-known cancer prevention drugs to women who seem to be at a high risk of developing blood clots in the legs and elsewhere, saying the risk from the clots may outweigh the risk cancer reduction benefits.
The task force did not weigh the cost of the cancer prevention drug mandate recommendation.
Goodrx.com, a drug price site, says the monthly retail cost for a monthly prescription for generic tamoxifen can range from $4 at the Kroger pharmacy, and $9 at Walmart and Sam’s Club, to $43 at CVS.