Medicare beneficiaries with heart disease or major cardiovascular risk factors reported less cost-related medication nonadherence after two provisions of the 2022 Inflation Reduction Act (IRA) limiting out-of-pocket drug costs took effect in January 2024, according to a Young Investigators Award study being presented at ACC.26 and simultaneously published in JACC.

The two new policy changes included expanded eligibility for "extra help" subsidies, which reduce drug copayments for individuals with incomes up to 135% of the federal poverty level to include those with incomes up to 150% of the federal poverty level. They also eliminated the 5% coinsurance requirement for catastrophic coverage, essentially capping the amount a person will spend on out-of-pocket drug costs. Researchers compared National Health Interview Survey data from 2024 when these provisions took effect against prior years and conducted several analyses to gauge trends in self-reported medication nonadherence among Medicare beneficiaries.

In one analysis, researchers compared responses from 4,710 Medicare beneficiaries aged 65 years and older with incomes below 135% of the federal poverty level (who were eligible for "extra help" subsidies before 2024) and 923 beneficiaries with incomes between 135% and 150% of the federal poverty level (who were newly eligible for the full subsidies starting in 2024). The results showed a 5.5 percentage point decrease in reported cost-related medication nonadherence among beneficiaries who were newly eligible for the subsidies.

In another analysis, researchers compared responses from 25,522 Medicare beneficiaries aged 65 years or older with a control group of 5,332 privately insured respondents aged 60-64 years, and found that cost-related medication nonadherence dropped by 2.1 percentage points among Medicate beneficiaries compared with the control group. This trend held true even after adjusting for income, race and ethnicity, employment status and educational attainment. There was no change in health care-related financial strain.

A third analysis examined responses from Medicare beneficiaries with incomes above 150% of the federal poverty level and those with incomes below 135% of the federal poverty level. That analysis did not show a significant difference in medication nonadherence between these groups.

"In the low-income group, we saw a pretty big benefit – it really helped people afford their medications," said Lucas Marinacci, MD, the study's lead author. "Our findings suggest that the 2024 IRA provisions supported better medication adherence, and better adherence may translate into better health."

Based on the results, researchers estimated that around 70,000 low-income seniors did not skip or delay medication doses in 2024 who otherwise would have done so in the absence of the policy changes. "Cardiology providers should continue asking Medicare patients about cost barriers and connecting them to financial counselors who can help them understand their drug coverage and take advantage of these reforms," Marinacci said. "If clinicians aren't aware of this and don't tell their patients, oftentimes people may forego medications that they could otherwise afford if they were aware of the policy."

Since the study is based on survey data, researchers said that it may be affected by inconsistencies in how respondents self-reported their health conditions or medication adherence behavior. In addition, the study did not assess health outcomes, and Marinacci said that future studies could examine whether the observed trends in medication adherence translate into improved health outcomes. He said that other data sources such as pharmacy claims could be used to evaluate the potential impacts of the change in catastrophic coverage on medication adherence. In addition, in light of subsequent changes in policy related to prescription drug costs that have occurred since 2024, he said it would be useful to assess the impacts of those changes and the ways insurers respond to them.

Keywords: ACC Annual Scientific Session, ACC26, Medication Adherence, Drug Costs, ACC Advocacy, Policy