Breast Cancer Prevention
October 13, 2021
Breast Cancer Prevention
What is Breast Cancer?
Breast cancer is a disease in which malignant (cancer) cells form in the breast tissues. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.
The most common types are invasive ductal carcinoma and invasive lobular carcinoma, which can spread or metastasize to other parts of the body. Ductal carcinoma in situ, is also a type of breast cancer that has not spread to other tissues of the breast.
Which are the risk factors for breast cancer?
- Older age
- Obesity
- Drinking alcohol
- Personal history of breast cancer or benign (non-cancer) breast disease
- Inherited risk of breast cancer
- Dense breast - Having breast tissue that is dense on a mammogram
- Exposure of breast tissue to estrogen made in the body - Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. Other factors the increased estrogen levels:
o Early menstruation
o Starting menopause at a later age
o Older age at first birth or never having given birth
- Taking hormone therapy for symptoms of menopause, such as estrogen and progesterone, which may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed.
- Radiation therapy to the breast or chest – increased risk can be seen up to ten years after treatment.
o The risk of breast cancer depends on the radiation dose and the age at which it is given.
o The risk is highest if radiation treatment is used during puberty when breasts are forming.
o Radiation therapy to treat cancer in one breast does not appear to increase cancer risk in the other breast.
How can we prevent breast cancer?
- Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer:
o Early pregnancy and breastfeeding (if possible) result in lower estrogen levels
- Keep a healthy weight and exercise regularly. Women who exercise four or more hours a week have a lower risk of breast cancer. Most healthy adults should aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes of vigorous aerobic exercise weekly, plus strength training at least twice a week.
- Don't drink alcohol or limit alcohol intake to less than one drink a day
- Don't smoke
- Avoid exposure to radiation and environmental pollution
- Taking selective estrogen receptor modulators, such as raloxifen and tamoxifen, (which act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues) may lower the risk in pre- and post-menopausal women at higher risk.
o With either drug, the reduced risk lasts for several years or longer after treatment is stopped.
o Side effects include blood clots in the lungs and legs and hot flashes. It is essential to talk with your doctor about the risks and benefits of starting one of these drugs.
Use of aromatase inhibitors (anastrozole, letrozole) and inactivators (exemestane) lower the risk of both recurrence and new breast cancers in women who have a history of breast cancer.
References:
- National Cancer Institute: www.cancer.gov
- Mayo Clinic: www.mayoclinic.org
- Centers for Disease Control and Prevention: www.cdc.gov/cancer
- Medline Plus: www.medlineplus.gov
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Mental health parity and medication adherence
Understanding GLP-1 Medications The landscape of obesity management is evolving, with GLP-1 receptor agonist (RA) medications emerging as a significant player. These FDA-approved drugs have proven effective in helping individuals lose weight, prompting a shift in how they are viewed and covered by health plans. However, the cost implications and strategic decisions surrounding these medications require careful consideration by employer groups and their members. The Case for GLP-1 Medications GLP-1 RAs, originally developed for diabetes management, have shown remarkable efficacy in weight loss. With the growing prevalence of obesity and its associated healthcare costs, there's increasing pressure on health plans to cover these medications. Despite their high cost—annual retail pharmacy expenses can exceed $10,000 per patient—GLP-1 RAs offer potential downstream savings by reducing obesity-related comorbidities such as diabetes, hypertension, and cardiovascular disease. Balancing Coverage and Cost Historically, weight loss medications were deemed "lifestyle" drugs and excluded from coverage. However, the rising popularity of GLP-1 RAs and their demonstrated benefits are challenging this perspective. For plan sponsors, the decision to cover these medications involves balancing the high upfront costs with the potential for long-term savings on medical expenses related to obesity. Cost-Containment Strategies For payers choosing to cover GLP-1 medications, several cost-containment strategies can be employed: Formulary Management : Deciding on the placement of these medications within the formulary is crucial. Options range from not covering the drugs to placing them on a high-cost tier with patient cost-sharing. Prior Authorization and Step Therapy : Implementing these measures ensures that only patients with a proper diagnosis (e.g., ICD-10 code for obesity) access these medications, preventing misuse and overutilization. Prerequisite Programs : Requiring participation in wellness or nutrition programs before approving weight loss medications can encourage lifestyle modifications that complement pharmacological treatment. Specialist Restrictions : Limiting prescriptions to weight loss specialists, such as bariatric doctors or endocrinologists, ensures appropriate therapy and monitoring. Duration Limits : Establishing treatment guidelines, such as discontinuing medications if a target weight loss is not achieved within six months, helps manage long-term costs. The Role of Brokers and Employer Groups Brokers play a pivotal role in guiding employer groups through the complexities of covering GLP-1 medications. Understanding the cost-benefit dynamics and available cost-containment strategies enables brokers to provide informed recommendations that align with their clients' financial and health objectives. Employer groups, in turn, must weigh the potential benefits of covering these medications against their budgetary constraints and the overall well-being of their workforce. Member Education and Engagement Effective communication with members is essential to ensure they understand the coverage options and adhere to prescribed treatments. Educational initiatives can include: Patient Communication Programs : Providing information on medication adherence, compliance, and lifestyle modifications. Continuing Education : Ongoing programs to keep members informed about the benefits and proper use of weight loss medications. Monitoring and Support : Utilizing pharmacy and medical data to track outcomes and adjust strategies as needed. Balance the Scale with Expert Guidance from MC-Rx The adoption of GLP-1 medications for weight loss represents a significant advancement in obesity management. However, the high costs associated with these drugs necessitate careful planning and strategic implementation by brokers, employer groups, and members. By employing robust cost-containment strategies and prioritizing member education, health plans can navigate the financial challenges while delivering meaningful health benefits to their populations. MC-Rx, as a full-service pharmacy benefits manager, offers the expertise and tools to help clients optimize their coverage decisions and manage the complexities of incorporating GLP-1 medications into their health plans. Here are just a few of the GLP-1 strategies we use to shield our clients from excessive costs: Implementation of Drug Management Tools, which is critical to ensure proper utilization for GLP-1s. Strategic Benefit Design, which also protects clients from improper GLP-1 utilization. Clear Member Communication, which is crucial for proper adherence and compliance. When implemented with an existing client, the above-listed strategies helped them achieve $382,000 in cost avoidance for GLP-1s. With the right approach, the benefits of these medications can be realized, contributing to better health outcomes and potentially lowering overall healthcare costs in the long run. For more information on managing GLP-1 medications and other pharmacy benefits, reach out to an MC-Rx expert today .
Mental Health Parity and Medication Adherence
MC-Rx, powered by ProCare Rx, has been notified by the Academy of Managed Care Pharmacy (AMCP) of the acceptance of their abstract, “Improving Adherence to HIV PREP via a PBM-Driven Educational Intervention” , for presentation at AMCP 2024 Conference in April.
Exploring the rising costs and demands of weight-loss medication and how to combat those costs, significantly lowering drug costs for payors and increasing access for patients who need them.
A message from Marileny Lugo, President, MC-Rx
A message from Marileny Lugo, President, MC-Rx
To decrease the burden on healthcare costs, at MC-Rx we strive to create awareness by educating our community regarding the importance of prevention.
Increased medication adherence has been linked to better clinical and financial outcomes.
