The high cost of medication is causing breast cancer survivors to forego follow-up treatment.

For many breast cancer survivors, taking medication is an important part of their follow-up treatment, helping curb the production of the hormone estrogen or preventing the hormone from attaching to new cancer cells. But a new study from researchers at  The University of Texas Health Science Center at Houston has found as many as a third of women wind up going off their medications, despite the long-term benefits for their health. Why? The out-of-pocket costs are simply too high.

For their study, the researchers reviewed the medical records of nearly 8,700 women enrolled in Medicare Part D prescription drug plans between 2007 and 2009, comparing the number of women who continued to take their prescribed medications with the out-of-pocket costs associated with their therapies. What they found was that about 37% - more than a third - did not fill their medications routinely during the study period, with compliance the lowest among those whose out-of-pocket costs exceeded $10 per prescription. Compliance was also lower for single women living in poor communities compared to women who were married or living in more affluent neighborhoods. Rates of adherence were similar for black, white and Hispanic patients, the study authors noted.

Without these medications, many breast cancer survivors may be more prone to cancer recurrence or experience higher rates of cancer-related mortality, the researchers noted. The findings are especially important now that the Affordable Care Act (ACA) faces an uncertain future. The ACA offers subsidies that cover many out-of-pocket prescription costs, which means women who depend on ACA and Medicare may be more likely to face greater out-of-pocket costs in the near future.

Should counseling before genetic testing for breast cancer be required? This is the debate between insurers and healthcare providers.

What is Genetic Testing?

Genetic testing has become a way of alerting women of their heightened risk for breast cancer. They test for BRCA1 and BRCA2 - two genetic mutations associated with breast and ovarian cancer. Through the analysis of these tests, doctors are able to identify those who are likely to get the disease and be able to discuss preventative measures.

What is Genetic Counseling?

Genetic counseling is the process in which patients at high risk for an inherited disease are advised on the nature of their disorder. Certified Genetic Counselors hold a Master's of Science degree in genetic counseling and are expert educators, as well as highly skilled in translating "medical terms" into more easily understood language. They support patients and their families during the diagnosis and help with treatment options and decision making.

Healthcare Providers vs. Insurers

Healthcare providers believe that counseling should not be required before women have genetic testing done. It has long been a normal practice for obstetrician-gynecologists to counsel women of hereditary cancers and keep track of each individual's medical history. If they know a patient's biological family member had breast cancer, they would be capable enough to inform them of their high-risk for the disease.

Insurers, on the other hand, disagree. Two of which, large national insurers, UnitedHealthcare and Cigna require women to seek genetic counseling by a certified genetic counselor before approving tests. According to Dr. Jeffrey Hankoff, a Cigna official. “We had concerns that people were having testing ordered that didn’t appear to need it and probably didn’t understand it.” Thus, driving up supply and costs for unnecessary tests.

Should counseling before genetic testing be required?

In addition to insurers, genetic counselors believe so. They are the experts - why shouldn't they be the ones to gather the extensive family background information. Some of which may not be covered during routine paperwork. However, with the thriving request for genetic testing, keeping up with the demand could be trying.

In the end, both parties agree that it is of utmost importance to refer any woman with a family history of breast cancer for genetic testing. What they can’t seem to come to an agreement on is the steps leading up to it.