Cost and Effectiveness of Tamoxifen Compared to Aromatase Inhibitors

For women who have estrogen receptor-positive breast cancers, the cost of hormonal therapy is an important consideration. This type of therapy is usually recommended after primary treatment with surgery and possibly chemotherapy and/or radiation therapy.

The two main choices of hormonal therapy are:

The costs can be very different, which may influence your decision. However, the cost isn't the only factor to consider.

If you're having trouble paying for these drugs, options may be available to help you.

Hormone Therapy and Risk of Breast Cancer Recurrence

After primary treatment for breast cancer, there is a risk of recurrence. With estrogen receptor-positive tumors, late recurrences, several years or even decades after treatment, 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, so both reducing the amount of estrogen in your bloodstream and blocking estrogen receptors can help protect you from growing new tumors.

While tamoxifen and aromatase inhibitors both prevent recurrence 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 only

  • Reduces recurrence risk by about 50 percent

  • Older, less expensive drug

Aromatase Inhibitors

  • Anti-estrogen effects

  • For premenopausal and postmenopausal women

  • May be more effective than tamoxifen in premenopausal women

  • Newer and more expensive

Cost: Tamoxifen vs Aromatase Inhibitors

Since tamoxifen is the oldest and most prescribed hormonal therapy, it tends to be one of the cheapest options.

Below are the pre-insurance, U.S. prices for a month's supply of the brand name and generic drugs as well as the lowest costs found using coupons or prescription-assistance programs.

Tamoxifen:

  • Brand name (Nolvadex/Soltamox)=$70
  • Average=$70
  • Generic=$70
  • Lowest=$20

Armidex:

  • Brand name=$560
  • Average=$170
  • Generic (anastrozole)=$140
  • Lowest=$8

Femara:

  • Brand name=$750
  • Average=$310
  • Generic=No generic form available
  • Lowest=$11

Aromasin:

  • Brand name=$1,160
  • Average=$505
  • Generic=$95
  • Lowest=$95

Keep in mind that the lowest prices often come from coupons, which may come and go, or prescription programs that you may not qualify for.

Paying for Hormonal Therapy

The costs of these medications to you can vary considerably based on your insurance coverage. In addition, some insurance companies will cover one type of aromatase inhibitor and not another.

If you are having difficulty with the cost, a few options.

Work With Your Doctor and Insurance Company

The first step if the cost of your medication is too high is to talk to your doctor. He or she may believe a more expensive drug is the best one for protecting your health. If not, ask for a less expensive one. Also, be sure to ask about generics.

If the medication your doctor thinks is best isn't in your insurance company's formulary, your doctor may be able to complete a prior authorization so that it is covered.

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 affording the prescription your doctor feels is best, there are more options. Some of these include:

  • Patient Prescription Assistance Programs: Learn more about the different patient prescription assistance programs available and check with drug manufacturers for assistance and savings programs. 
  • Prescription drug discount programs: Learn more about who may benefit from a drug discount card and when they may help.
  • Ask for samples: Some oncologists are provided samples of aromatase inhibitors. It can't hurt to ask.
  • Check into disability: If you are not yet 65 but can qualify for disability, you may be able to get your medication through Medicare.
  • Online pharmacies: Before you go online, learn about how to safely order drugs online.
  • State pharmaceutical assistance programs: Many U.S. states have discount or assistance programs. Check to see if your state offers coverage.
  • Non-profit assistance: Ask your doctor or clinic about local organizations that provide assistance with the cost of prescriptions. You can also check with the organizations that provide breast cancer advocacy. Keep in mind that different organizations have different goals. Some try to effect change at the National level. Some aim at funding research. Still others have a goal of helping individual people cope with cancer today, such as affording the cost of prescription medications.

    Keep Careful Records

    With insurance changes often requiring greater contributions from those who are insured, keeping careful records is more important than ever. Many costs for cancer treatment are tax deductible, including the out-of-pocket cost of hormonal therapy.

    A Word From Verywell

    Hormone therapy is recommended for a full 5 to 10 years after the primary treatment of breast cancer, so the cost of your medications is an important factor to consider.

    Never settle for paying the full retail price of a drug, though. Explore your options so that you aren't paying more than you need to.

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