Patients & Providers Know Best: Insurers Must Allow Open Access to Lifesaving Breast Cancer Treatments

My Patient Rights > Patients & Providers Know Best: Insurers Must Allow Open Access to Lifesaving Breast Cancer Treatments

Patients & Providers Know Best: Insurers Must Allow Open Access to Lifesaving Breast Cancer Treatments

October is Breast Cancer Awareness Month, marking a time for advocates all over the country to participate in fundraisers, campaigns, festivals and walks/runs to show their support for those living with and affected by the disease. There is much to celebrate, as the future for breast cancer survivors looks optimistic (the number of breast cancer survivors is projected to grow to 26 million by 2040), but beyond the pink ribbons and merchandise giveaways lies an urgent issue for those diagnosed with breast cancer: timely access to care.

Patients undergoing metastatic breast cancer treatment may be prescribed a Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor, of which there are three that have been approved by the US Food and Drug Administration. These inhibitors are drugs administered to interrupt the growth of cancer cells and are often used in combination with hormone therapy.

Cancer patients in California deserve timely care tailored to their unique health needs. Unfortunately, issues like prior authorization and step therapy are preventing some patients from accessing the proper CDK4/6 treatment for metastatic breast cancer. FDA-approved treatment options are often out of reach due to formulary restrictions and utilization management protocols. Requiring patients to try medications other than what their doctor prescribed simply to meet arbitrary insurance requirements can worsen cancer symptoms and allow for disease progression. In many cases, it also impacts patients’ out-of-pocket costs, as utilization management protocols also steer patients toward using more expensive treatments first. In the worst-case scenario, it can lead to death.

For example, a patient with metastatic ER+ HER2 negative breast cancer who failed to see results from the single agent endocrine therapy might benefit from a specific CDK4/6 inhibitor plus endocrine therapy. But, her insurance might want her to try a different treatment first, despite the provider showing evidence that the insurance-preferred treatment was not the ideal choice for this specific patient.

However, each patient is unique and different cases call for different treatments. Therein lies the importance of the physician exercising free choice over which treatment option is the best for the patient. Patients and physicians must have a say in their treatment, without barriers and without delay.

In 2019, more than 180,000 new cancers were diagnosed in California, and 59,099 people passed away from their illness. Additionally, breast cancer is among the most common cancers diagnosed and among the most common cancer deaths. These startling statistics remind us that every second matters for a newly diagnosed breast cancer patient. Effective treatment must be timely and highly personalized.

Moreover, breast cancer is one of the leading causes of death among Black women, with Black women dying from breast cancer at a 41% higher rate than their white counterparts. Individuals affected by socioeconomic factors cannot experience further obstructions to timely health care.

If you are a breast cancer patient or a provider experiencing issues with accessing any of the three CDK4/6 inhibitors, we want to hear your story and help you get the care you need and deserve. Message us here or email us at

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