Navigating Insurance Hurdles and Policy Shortfalls in Breast Cancer Care: Anasuya Gunturi, MD, PhD

At the recent regional Institute for Value-Based Medicine® event in Boston, Anasuya Gunturi, MD, PhD, medical director of the cancer center and chief of hematology/oncology, Lowell General Hospital, was a panelist for the discussion, “Evolving Breast Cancer Care: Addressing Unmet Needs Across the Patient Journey.” With her fellow discussants—Adrienne Waks, MD; Michael Hassett, MD, MPH; and Leticia Varella, MD, of Dana-Farber—she spoke from the perspective of a community oncologist.

Here in part 1 of her interview with The American Journal of Managed Care®, she speaks to the inherent difficulties seen even from diagnosis for patients living with breast cancer. These difficulties include navigating insurance and access to targeted treatment for their disease.

“I have to say, in my practice, it's not uncommon that a lot of my patients do struggle with accessing some of these newer and sometimes more effective treatments for their breast cancer,” she explains.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What systemic gaps contribute to disparities in biomarker testing and access to targeted therapies, and what should be policy priorities to address these inequities?

Before you even get to the treatment stage, there are so many disparities and policy changes that probably need to be looked at even for a patient's journey to diagnosis. We all know that the percentages of women who get their screening mammograms [are] quite high compared to a lot of other screenings that are out there, but there are still gaps, especially in certain populations. I think there's a whole conversation about that, but once the diagnosis is made, the field is moving more and more toward targeted therapies and newer agents that are coming on the market—it seems like every month.

Our patients’ ability to access those drugs really does depend on so many factors: their ability to navigate the health care system in general, showing up for appointments, getting enrolled in clinical trials. Once a drug is prescribed, there's a whole process that has to happen with financial clearance and prior authorizations and all of this stuff that happens. For some patients, they have “good” insurances and it's a smooth journey to treatment, and for others, for whatever reason, it just takes weeks or months. Sometimes I even have to change the agent because I'm told that their insurance doesn't cover this particular drug.

Yes, there need to be some policy changes. I'm not, obviously, savvy enough to know what influences these insurances and what kind of guidelines and things that they need to adhere to, but I have to say, in my practice, it's not uncommon that a lot of my patients do struggle with accessing some of these newer and sometimes more effective treatments for their breast cancer, and I have to resort to, sometimes, probably equally good but may not be the latest in the field.