Daytona Beach News – Journal
Patients battling breast cancer deserve full access to their prescribed treatments
By Jeri Francoeur, Daytona Beach News-Journal – October 4, 2023
I am a two-time breast cancer survivor, and have made it my life’s mission to ensure cancer patients have the resources they need to navigate health insurance and other access barriers. I have been involved in advocacy for all patients since I first started working in the medical field.
My personal breast cancer advocacy story began 20 years ago. My best friend was diagnosed with inflammatory breast cancer and was given a 7% chance of surviving. I watched her struggle to find affordable treatment options while time ran out. She lost her battle. I was devastated, and I knew I would never let another woman go through what my friend went through.
Six months later, I felt a change in my breast tissue. As a physician’s assistant who taught women how to perform self-breast exams, I had a pretty good idea something was off. After my mammogram showed no abnormalities, I begged my healthcare provider to run more tests. A biopsy showed I had noninvasive ductal carcinoma in situ, which is stage zero breast cancer. I was lucky to have a medical background and knew how to advocate for myself through my diagnosis – especially when I was diagnosed again in 2020.
I know the importance of early detection and treatment for breast cancer patients. In the last 10 years, breast cancer treatment development has been incredible. Innovative medicines that offer more effective treatment and fewer side effects are now on the market. Breast cancer patients are now living longer thanks to remarkable research.
Some insurance plans, unfortunately, prevent patients from accessing these innovative and effective treatments. This is the current situation regarding CDK4/6 inhibitors. CDK4/6 inhibitors treat patients with HR+/HER2- metastatic breast cancer and are rapidly transforming patient outcomes. All three CDK4/6 inhibitors on the market have gained FDA approval, yet they are not all accessible to patients because of insurance barriers.
One of the ways insurance companies can attempt to block access to new and effective treatments like these is by mandating doctors and patients submit to step therapy. Also known as “fail first,” step therapy requires patients to first prove that older, less expensive, or insurer-preferred alternative medications don’t work before coverage is approved for the medicine prescribed for them.
Breast cancer is a serious, life-threatening condition. Implementing step therapy protocols that require patients to try any medicine other than what the doctor prescribed takes away a patient’s valuable time. It allows breast cancer to progress and causes side effects that diminish patients’ quality of life. Breast cancer patients suffer when they cannot get the treatments their medical team prescribes.
No one should stand in the way of patients and their healthcare providers. Healthcare providers have years of education, clinical experience, specialized training, and, most importantly, know their patients. They are the most qualified to create a personalized treatment plan that fits their patient’s needs and tolerance levels.
Breast cancer patients deserve the highest level of care. New and innovative treatment options can help change the breast cancer landscape as we know it. It’s time insurance companies do what’s right and provide equal coverage for treatments that are proven to save lives.
Jeri Francoeur is a two-time breast cancer survivor, patient advocate, and founding member of the Florida Cancer Support Network. She resides in Ormond Beach.