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Paying for Cancer Screening and Prevention

Locate medical experts and find information on insurance coverage and financial assistance for risk management, treatment and follow up care.

Paying for breast cancer risk-reducing medication

Tamoxifen and raloxifene are approved breast cancer risk reduction medications for high-risk women. The Affordable Care Act requires insurance companies to pay for tamoxifen or raloxifene with no out-of-pocket expenses for women ages 35 and older who meet the United States Preventive Services Task Force (USPSTF) guidelines. However, the laws do not apply to women below age 35 and some high-risk women may not be eligible, even if they have a BRCA mutation. Most insurance companies will cover the cost of tamoxifen or raloxifene for high risk women who don't meet USPSTF  eligibility guidelines, however there may be some out-of-pocket costs involved. If your insurance company denies this medication, visit our health insurance appeals page for information on insurance appeals. 

Federally qualified health centers (also called “Community Health Centers”) can be a resource to anyone who needs financial assistance with their healthcare journey. Their mission is to provide care regardless of ability to pay. They often are the most knowledgeable about which other providers and organizations in their local community offer services at discounts, sliding fee scales, etc.  Their main focus is providing prevention services such as screenings.

All of the centers must provide access to mental health services and many provide access to general living assistance programs (energy assistance, child care assistance, housing assistance, etc.) 

Breast cancer risk-reducing medication within research
Some clinical trials are studying medications to lower the risk for breast cancer. The cost of medication included in these studies may be covered for participants. The following clinical trials are studying agents to lower the risk for breast cancer in high risk women:

Visit our HBOC research search tool to find additional prevention and detetion research studies. 

 

Updated 12/23/15

FORCE:Facing Our Risk of Cancer Empowered