The Cost of Tamoxifen vs. Aromatase Inhibitors

What to Expect and Affording Treatment

Some breast cancer is affected by estrogen, a sex hormone common in women’s bodies. These are called estrogen receptor-positive breast cancers. The cancer cells have receptors on them that are stimulated to grow and spread when estrogen is present.

Breast cancer is typically treated first with surgery and possibly chemotherapy and/or radiation therapy. After the primary treatment, many doctors then prescribe hormone therapy. These medications either stop estrogen from reaching the cancer cells, or they reduce the amount of estrogen that a woman’s body makes.

There are two main kinds of hormone therapy drugs: the hormone receptor blocker tamoxifen (brand name Nolvadex or Soltamox), and aromatase inhibitors such as Arimidex (anastrozole), Femara (letrozole), and Aromasin (exemestane).

The cost of hormone therapy can be an important consideration when working with your healthcare provider on a treatment plan. The costs can vary between these kinds of drugs, which may influence your decision.

This article will discuss the differences between tamoxifen and aromatase inhibitor medications, and explain medication assistance programs. 

Cancer Patient Reviewing Prescriptions
FatCamera / Getty Images

Hormone Therapy and Risk of Breast Cancer Recurrence

After primary treatment for breast cancer, there is a risk of recurrence, when the cancer is in remission (no detectable cancer) and then comes back.

With estrogen receptor-positive tumors, late recurrences are more common than with other types of breast cancer. Hormone therapies have been shown to reduce the risk of recurrence and improve survival rates.

Basically, estrogen is fuel for this type of tumor. Reducing the amount of estrogen in your bloodstream or blocking estrogen receptors can help protect you from growing new tumors, which reduces the risk of your cancer coming back.

While tamoxifen and aromatase inhibitors both prevent recurrence of estrogen-receptor positive breast cancer, they do work in different ways and for different people.

Tamoxifen
  • Anti-estrogen and estrogen-like effects

  • For premenopausal women

  • Reduces recurrence risk by about 50%

  • Older, less expensive drug

  • Blocks estrogen from binding to breast cancer cells

Aromatase Inhibitors
  • Anti-estrogen effects

  • For postmenopausal women

  • Help reduce risk of cancer recurrence

  • Newer and more expensive

  • Stop the body from making estrogen

Comparing Costs

Many women are prescribed hormone therapy for five to 10 years, so the cost can be an important consideration. Tamoxifen is the oldest and most prescribed hormone therapy. Therefore, it tends to be one of the cheapest options.

Below are the pre-insurance, U.S. prices for a month’s supply (30 days) of the brand name and generic versions of tamoxifen and aromatase inhibitors. The lowest costs found using coupons or prescription-assistance programs are also listed.

Work with your doctor and compare the costs of the medications that are recommended for you. 

  Nolvadex/Soltamox (tamoxifen) Arimidex (anastrozole) Femara Aromasin (exemestane)
Brand Name Not available $1,897 $849 $1,402
Average N/A $1,355 $690 $1.084
Generic $67 $130 $220 $430
Lowest $17 $6 $8 $33

The lowest prices may have special requirements. Some have coupons that may come and go. Other low prices may be the result of prescription programs that have strict qualifications.

Paying for Hormone Therapy

The costs of these medications can vary considerably based on your insurance coverage. In addition, some insurance companies will cover one type of hormone therapy but not another. Check your insurance coverage and discuss your options with your doctor.

If you are having difficulty affording hormone therapy, you have a few options.

Work With Your Healthcare Provider and Insurance Company

Your first step should be to talk to your healthcare provider and ask about generic options. Share your concerns about affording medications with your prescriber. 

If the medication your healthcare provider thinks is best is not in your insurance company’s formulary, you have some options:

  • You may be able to use a similar medication that is covered by insurance. 
  • Your healthcare provider may be able to complete a prior authorization request to get the medication covered. 
  • You may also be able to file to appeal the decision. 
  • Even if you do have private health insurance, look into your eligibility for Medicare Part D or Medicaid.

If you need to work something out with your insurance company, it may be easier to talk in person than over the phone if you have a local office or representative.

Prescription Assistance Programs

If you are still having difficulty paying for the prescription your healthcare provider feels is best, there are more options. Some of these include:

  • Patient assistance programs: Learn more about the different patient prescription assistance programs available, and check with drug manufacturers for further assistance and savings programs. 
  • Drug discount programs: You may be eligible for a prescription drug discount card.
  • Samples: Some oncologists are provided samples of aromatase inhibitors. It can’t hurt to ask.
  • Disability: If you are not yet 65 but can qualify for disability, you may be able to get your medication through Medicare.
  • Online pharmacies: You may find more affordable prices at online retailers. Before you buy, learn about how to safely order drugs on the web.
  • State pharmaceutical assistance programs: Many states have discount or assistance programs. Check to see if your state offers coverage.
  • Nonprofit assistance: Ask your healthcare provider or clinic about local organizations that provide assistance with the cost of prescriptions. You can also check with breast cancer advocacy organizations. Keep in mind that different organizations have different goals, which may or may not include helping patients afford treatment.

Keep Careful Records

Keeping careful records is more important than ever. Insurance requirements change often. Proving your own costs may be required for the insurance to cover your drug.

Many costs for cancer treatment are tax deductible, including the out-of-pocket cost of hormone therapy medications. Good record keeping will help you to prove your expenses at tax time.

Summary

People with estrogen-positive breast cancers may benefit from hormone therapy to prevent cancer from returning. Tamoxifen and aromatase inhibitors are two types of medications that may help. They vary in cost and use, so talk with your doctor about what treatment is most appropriate for you. Work together to figure out how to manage the cost of these medications.

A Word From Verywell

Hormone therapy is recommended for a full five to 10 years after the primary treatment of breast cancer, so the cost of tamoxifen or your aromatase inhibitor is an important factor to consider. You rarely need to pay the full retail price of the drug. With some effort exploring your options, you may be able to significantly lower your overall spending on treatment.

Frequently Asked Questions

  • Is hormone therapy typically covered by insurance?

    Typically, some type of hormone therapy is covered, but the specific medication may vary. Each insurance plan has a formulary that lists the specific medications that are covered. Some insurance plans cover medications in different tiers, or levels, of cost.

  • What are the benefits of hormone therapy?

    Hormone therapy slows current cancer cell growth and prevents cancer from coming back after remission. Research studies also show less death from breast cancer in people who take hormone therapy medications.

  • Does hormone therapy weaken the immune system?

    Each hormone therapy medication has specific side effects. However, because these medications work on estrogen, they do not directly affect the immune system. Immune system suppression is more frequently a side effect of chemotherapy (cancer-killing) drugs.

  • Are there long-term side effects from hormone therapy?

    There can be some serious long-term side effects from hormone therapy. Tamoxifen can raise the risk of uterine cancer and blood clots. Aromatase inhibitors more often cause joint or muscle pain. They may even cause bones to weaken and break. Talk to your doctor about the risks and benefits of any medications that are being recommended.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. American Cancer Society. Hormone therapy for breast cancer.

  3. National Cancer Institute. Breast cancer treatment (adult) (PDQ®)—health professional version.

  4. Pan H, Gray R, Braybrooke J, et al. 20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. N Engl J Med. 2017;377:1836-1846. doi:10.1056/NEJMoa1701830

  5. Visvanathan K, Fabian CJ, Bantug E, et al. Use of endocrine therapy for breast cancer risk reduction: ASCO clinical practice guideline updateJ Clin Onocol. 2019;37(33):3152-3165. doi:10.1200/JCO.19.01472

  6. Centers for Medicare and Medicaid Services. Information on essential health benefits (EHB) benchmark plans.

  7. Early Breast Cancer Trialists’ Collaborative Group. Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trialsLancet. 2015;386(10001):1341-1352. doi:10.1016/S0140-6736(15)61074-1

  8. National Cancer Institute. Hormone therapy for breast cancer.

  9. MedlinePlus. Hormone therapy for breast cancer.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
Learn about our editorial process