Out-of-Pocket Drug Costs for Medicare Beneficiaries With Cardiovascular Risk Factors Under the Inflation Reduction Act.

Narasimmaraj PR, Oseran A, Tale A, Xu J, Essien UR, Kazi DS, Yeh RW, Wadhera RK. Out-of-Pocket Drug Costs for Medicare Beneficiaries With Cardiovascular Risk Factors Under the Inflation Reduction Act. Journal of the American College of Cardiology. 2023 Apr 18; 81(15):1491-1501.

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Abstract:

BACKGROUND: High out-of-pocket prescription drug costs contribute to financial toxicity, medication nonadherence, and adverse cardiovascular (CV) outcomes. Policymakers recently passed the Inflation Reduction Act, which will cap Medicare out-of-pocket drug costs at $2,000/year and expand full low-income subsidies (LIS). It is unclear how these provisions will affect Medicare beneficiaries with CV risk factors and/or conditions. OBJECTIVES: The authors sought to characterize the population of Medicare beneficiaries with CV risk factors/conditions experiencing out-of-pocket prescription drug costs > $2,000/year and estimate their potential savings under the Inflation Reduction Act''s spending cap; identify sociodemographic characteristics associated with out-of-pocket costs > $2,000/year; and characterize beneficiaries newly eligible for LIS under the Inflation Reduction Act. METHODS: This was a cross-sectional study of Medicare beneficiaries aged  = 65 years with  = 1 CV risk factor/condition from 2016 to 2019. RESULTS: An annual estimated 34,056,335 ± 855,653 Medicare beneficiaries (mean ± SE) had  = 1 CV risk factor/condition, of whom 1,020,484 ± 77,055 experienced out-of-pocket drug costs > $2,000/year. The likelihood of experiencing out-of-pocket drug costs > $2,000/year was lower among adults  = 75 years vs 65 to 74 years (adjusted OR: 0.67; 95% CI: 0.49-0.93) and for low-income vs higher-income adults. Among beneficiaries currently spending > $2,000/year, estimated median out-of-pocket drug savings would be $855/year and total annual savings $1,723,031,307 ± $91,150,609 under the Inflation Reduction Act. An estimated 1,289,861 beneficiaries would also become newly eligible for LIS. CONCLUSIONS: More than 1 million older adults with CV risk factors and/or conditions spend > $2,000/year out-of-pocket on prescription drugs and will likely benefit from the Inflation Reduction Act''s cap, with estimated total out-of-pocket savings of $1.7 billion/year, while another 1.3 million will also become newly eligible for LIS.