Breast Cancer Prevention Drugs to be covered under the Affordable Care Act

In new guidelines issued by the Department of Health and Human Services (HHS) on January 9, 2014, certain medications that are intended to prevent breast cancer will be fully covered under the Affordable Care Act (ACA).

Congresswoman Ann McLane Kuster (NH-02) had previously called on HHS Secretary Kathleen Sebelius before the announcement to include this cancer treatment as a preventive service under most health insurance plans.  In her press release, the Congresswoman said, “We have a long way to go when it comes to treating and preventing cancer, and today’s announcement is an important step forward in that effort.”

The new coverage follows the U.S. Preventive Services Task Force (USPSTF) recommendation in September that “women at increased risk of breast cancer, due to age, family history or other factors, take drugs such as tamoxifen and raloxifene.”  The U.S. Preventive Services Task Force, a group of independent, volunteer physicians and academics, said it found “adequate evidence” that treatment with one of those drugs “can significantly reduce the relative risk (RR) for invasive ER-positive breast cancer in postmenopausal women who are at increased risk for breast cancer.”

According to HHS released language, “The USPSTF recommends that clinicians engage in shared, informed decision-making with women who are at increased risk for breast cancer about medications to reduce their risk.  For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications, such as tamoxifen or raloxifene.”  Now these women at increased risk can receive these preventive medications under many ACA health insurance plans without a co-pay or other out-of-pocket expenses.