For millions of older Americans living with heart disease, the cost of medication can be a crushing burden, forcing difficult choices between health and other essential needs. But new research suggests that recent changes to Medicare, stemming from the 2022 Inflation Reduction Act (IRA), are beginning to ease that strain. A study presented at the American College of Cardiology’s Annual Scientific Session and published in the Journal of the American College of Cardiology indicates a reduction in cost-related medication non-adherence among Medicare beneficiaries following the implementation of these reforms.
The findings, released in March 2024, offer early evidence that capping out-of-pocket drug costs and expanding financial assistance are making a tangible difference in the lives of seniors. This is particularly crucial given that heart disease remains the leading cause of death globally, and increasingly complex medication regimens – including newer drugs like GLP-1 receptor agonists and SGLT2 inhibitors – are vital for preventing serious cardiac events such as heart attack, and stroke. However, the expense of these medications can lead patients to skip doses or forgo prescriptions altogether, undermining their effectiveness.
Lowering the Barrier to Essential Medications
The Medicare changes took effect on January 1, 2024, and focused on two key areas. First, the reforms expanded eligibility for “extra help” subsidies, which help cover prescription drug costs for individuals with limited income. Previously available to those earning up to 135% of the federal poverty level, the program now includes those earning up to 150%. Second, the IRA eliminated the 5% coinsurance requirement for catastrophic coverage, effectively capping the annual out-of-pocket spending on drugs for those with exceptionally high medication costs. According to the Centers for Medicare & Medicaid Services, this cap is set at $2,000 per year.
Researchers analyzed data from the National Health Interview Survey, a nationally representative survey of U.S. Adults, to assess the impact of these changes. They compared self-reported medication adherence rates in 2024 with those from 2021-2023, focusing on individuals with a history of heart disease, stroke, high blood pressure, or other cardiovascular risk factors.
Significant Improvement for Low-Income Seniors
The study revealed a particularly significant benefit for those with the lowest incomes. Among 4,710 Medicare beneficiaries aged 65 and older with incomes below 135% of the federal poverty level, researchers observed a 5.5 percentage point decrease in reported cost-related medication non-adherence after the new subsidies took effect. “In the low-income group, we saw a pretty massive benefit—it really helped people afford their medications,” said Lucas Marinacci, MD, the study’s lead author and a physician at Beth Israel Deaconess Medical Center in Boston. The American College of Cardiology reported his statement.
Further analysis, comparing 25,522 Medicare beneficiaries with a control group of 5,332 privately insured individuals aged 60-64, showed a 2.1 percentage point drop in cost-related non-adherence among Medicare recipients. This improvement remained statistically significant even after accounting for factors like income, race, ethnicity, employment status, and education level. Importantly, the study did not find a corresponding increase in reported financial strain related to healthcare suggesting the reforms were specifically addressing medication costs.
An Estimated 70,000 Seniors Benefitting
Based on their findings, the researchers estimate that approximately 70,000 low-income seniors were able to avoid skipping or delaying medication doses in 2024 due to the IRA provisions. This suggests a real and measurable impact on access to care. Whereas the study didn’t directly assess health outcomes, researchers believe improved medication adherence is likely to translate into better health for those affected.
However, the benefits weren’t universally experienced. The analysis found no significant difference in medication adherence between beneficiaries with incomes above 150% of the federal poverty level and those below 135%. This highlights the targeted nature of the reforms and suggests that further interventions may be needed to address affordability challenges for a broader range of Medicare beneficiaries.
The Role of Clinicians in Raising Awareness
Researchers emphasize that the success of these reforms hinges on patients being aware of the available assistance. Many seniors may not fully understand the changes to their coverage, including the new cap on out-of-pocket costs. “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 advised. “If clinicians aren’t aware of this and don’t share their patients, oftentimes people may forego medications that they could otherwise afford if they were aware of the policy.”
The study acknowledges limitations, including its reliance on self-reported data, which can be subject to recall bias. Future research, utilizing pharmacy claims data, could provide a more objective assessment of medication adherence and the impact of the catastrophic coverage changes. Ongoing monitoring will be crucial to evaluate the effects of subsequent policy changes related to prescription drug costs.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It’s essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
Looking ahead, researchers plan to continue tracking medication adherence trends and evaluating the long-term health impacts of the IRA provisions. The next step will be to analyze pharmacy claims data to confirm these initial findings and assess the effects on specific cardiovascular outcomes. For more information on the Inflation Reduction Act and its impact on Medicare, visit the Centers for Medicare & Medicaid Services website. Share this article with anyone who might benefit from understanding these important changes to Medicare drug coverage.
