Medicare Beneficiaries See Drop in Medication Non-Adherence Following New Drug Cost Limits
New provisions limiting out-of-pocket drug costs for Medicare beneficiaries have led to a reported decrease in cost-related medication non-adherence among those suffering from heart disease or exhibiting significant cardiovascular risk factors. This positive trend includes fewer instances of skipping or reducing doses, delaying prescription fills, or foregoing medications due to cost.
These findings, presented at the American College of Cardiology's Annual Scientific Session (ACC.26) and published in JACC, offer initial evidence that Medicare reforms meaningfully reduced medication non-adherence.
Policy Changes Driving the Shift
The study specifically investigated the impact of two key provisions from the 2022 Inflation Reduction Act (IRA), which officially took effect on January 1, 2024. Researchers compared 2024 survey data with previous years to analyze trends in self-reported medication non-adherence among older adults with heart disease or major cardiovascular risk factors.
Dr. Lucas Marinacci, the study's lead author, highlighted a significant benefit within the low-income group, indicating improved affordability of medications. He noted that the 2024 IRA provisions supported better medication adherence, which holds the potential for improved health outcomes.
Heart disease remains a leading global cause of death. While both newer drug classes and conventional medications are crucial for reducing serious cardiac events, their combined cost has historically contributed to patients' non-adherence.
The two pivotal policy changes, enacted on January 1, 2024, to enhance prescription drug affordability for Medicare beneficiaries, included:
- Expanded "extra help" subsidies: The income threshold for eligibility was raised from 135% to 150% of the federal poverty level.
- Elimination of catastrophic coverage coinsurance: The 5% coinsurance requirement for catastrophic coverage was removed, effectively capping out-of-pocket drug costs.
Unpacking the Study: Methodology and Key Findings
Researchers utilized data from the National Health Interview Survey, a nationally representative survey of U.S. adults. Their focus was on trends in medication non-adherence among respondents reporting a history of coronary heart disease, angina, heart attack, stroke, transient ischemic attack, high blood pressure, high cholesterol, diabetes, or obesity. Participants were asked if they had skipped, reduced, delayed, or foregone medication doses due to cost, and if they experienced healthcare-related financial strain. Responses from 2024 were then compared with those from 2021-2023.
One key analysis involved 4,710 Medicare beneficiaries aged 65 and older with incomes below 135% of the federal poverty level (previously eligible for "extra help") and 923 beneficiaries with incomes between 135% and 150% (newly eligible for full subsidies in 2024).
This analysis revealed a significant 5.5 percentage point decrease in reported cost-related medication non-adherence among the newly eligible beneficiaries.
Another analysis compared 25,522 Medicare beneficiaries aged 65 or older with a control group of 5,332 privately insured respondents aged 60-64 years. This comparison showed that cost-related medication non-adherence dropped by 2.1 percentage points among Medicare beneficiaries relative to the control group. This trend remained consistent even after adjusting for income, race and ethnicity, employment status, and educational attainment. No change in health care-related financial strain was observed.
A third analysis, examining Medicare beneficiaries with incomes above 150% of the federal poverty level and those below 135%, did not demonstrate a significant difference in medication non-adherence between these groups.
Broader Implications and Expert Recommendations
Based on these results, researchers estimated that approximately 70,000 low-income seniors in 2024 avoided skipping or delaying medication doses due to these policy changes. This provides initial evidence that the Medicare reforms meaningfully reduced medication non-adherence, likely leading to improved health outcomes for some patients. The researchers suggested that similar changes to reduce out-of-pocket drug costs in other health insurance types, such as Medicaid or private insurance, could also yield comparable effects.
Researchers emphasized that patient awareness of these policy changes is critical for behavioral response. Given that many seniors may not fully understand their health coverage, clinicians are encouraged to play an active role in informing patients that their medications may now be more affordable than previously thought.
Dr. Marinacci stated that cardiology providers should continue to inquire about cost barriers with Medicare patients and connect them with financial counselors. This proactive approach would help patients understand their drug coverage and utilize these reforms, preventing them from foregoing necessary medications due to unawareness.
Acknowledging Limitations and Future Directions
The study's reliance on self-reported survey data may introduce inconsistencies in how respondents report their health conditions or medication adherence. Additionally, the study did not assess direct health outcomes.
Marinacci suggested that future studies could investigate whether these trends in medication adherence translate into improved health outcomes, potentially using pharmacy claims data to evaluate the impact of changes in catastrophic coverage. Further research could also assess the effects of subsequent policy changes related to prescription drug costs and how insurers respond to them. The study was funded by the National Institutes of Health.