After new provisions limiting out-of-pocket drug costs for Medicare beneficiaries went into effect, Medicare beneficiaries with heart disease or major cardiovascular risk factors reported decreased cost-related rates of noncompliance, reducing dosages, delaying filling prescriptions, or discontinuing medications due to cost, according to a study presented at and concurrently with the American College of Cardiology’s Annual Scientific Meeting (ACC.26). jackACC’s flagship journal.
This study focuses on the impact of two provisions of the Inflation Control Act of 2022 (IRA), which took effect on January 1, 2024. Researchers compared 2024 survey data with previous years to analyze trends in self-reported medication nonadherence among older adults with heart disease or major cardiovascular risk factors.
We’ve seen a pretty big benefit in low-income groups, really helping people afford the drug. Our findings suggest that the 2024 IRA provisions support improved medication adherence and that improved medication adherence may lead to improved health outcomes. ”
Lucas Marinacci, M.D., physician at Beth Israel Deaconess Medical Center, faculty member at the Richard A. Susan F. Smith Outcomes Research Center in Boston, and lead author of the study
Heart disease is the leading cause of death worldwide. New drug classes such as GLP-1 receptor agonists, SGLT2 inhibitors, and novel anticoagulants are gaining attention alongside traditional cholesterol and blood pressure-lowering drugs to reduce the risk of serious cardiac events in people with atrial fibrillation, heart failure, or a history of heart attack or stroke. However, these drug combinations can be expensive, and previous studies have shown that patients may not take their medications as prescribed if they feel they cannot afford them.
The policy changes that took effect on January 1, 2024 included two provisions aimed at making prescription drugs more affordable for Medicare beneficiaries. One provision expanded eligibility for “special needs” subsidies that reduce drug copayments for individuals with incomes up to 135 percent of the federal poverty level, and also included individuals with incomes up to 150 percent of the federal poverty level. Another provision removed the 5% coinsurance requirement for catastrophic coverage, effectively placing a cap on individual out-of-pocket drug costs.
Researchers used data from the National Health Interview Survey, a nationally representative survey of U.S. adults, to analyze trends in medication noncompliance among respondents who reported a history of coronary heart disease, angina (chest pain or tightness), heart attack, stroke, transient ischemic attack, high blood pressure, high cholesterol, diabetes, or obesity. Survey questions asked participants whether they had stopped, reduced, delayed, or stopped taking prescription medications because of cost (cost-related noncompliance) and whether they were worried about or were unable to pay their medical bills (health-related financial burden). To analyze changes related to new Medicare regulations, researchers compared survey responses in 2024 with responses from 2021 to 2023.
In one analysis, researchers compared the responses of 4,710 Medicare beneficiaries age 65 and older with incomes below 135% of the federal poverty level (those who were eligible for the “special needs” subsidy before 2024) and 923 beneficiaries with incomes between 135% and 150% of the federal poverty level (those newly eligible for the full subsidy starting in 2024). Results showed a significant 5.5 percentage point reduction in reported cost-related noncompliance among newly eligible recipients of the subsidy.
In a separate analysis, researchers compared responses from 25,522 Medicare beneficiaries ages 65 and older to a control group of 5,332 privately insured respondents ages 60 to 64. They found that cost-related noncompliance decreased by 2.1 percentage points among Medicaid beneficiaries compared with the control group. This trend held true even after controlling for income, race, ethnicity, employment status, and education. There was no change in the medical-related financial burden.
The third analysis examined the responses of Medicare beneficiaries with incomes above 150% of the federal policy level and Medicare beneficiaries with incomes below 135% of the federal poverty level. That analysis showed no significant differences in medication nonadherence between these groups.
Based on the results, the researchers estimated that about 70,000 low-income older adults did not skip or delay their medications in 2024, but would have done so had it not been for the policy changes that took effect that year. This provides early evidence that Medicare reform has had meaningful benefits in terms of reducing medication nonadherence, which the researchers say is likely to lead to improved health outcomes for some patients. Researchers said similar changes to reduce out-of-pocket drug costs could have similar effects for people with other types of health insurance, such as Medicaid or private insurance.
However, the researchers said patients were likely to change their behavior in response to a policy change only if they were aware of what the change meant for them. Because many older adults have a hard time understanding their health insurance — some Medicare beneficiaries, for example, may not know that their total out-of-pocket costs are limited under an IRA — Marinacci said clinicians need to take an active role in helping patients understand that their medications may be more affordable than they think.
“Cardiologists need to continue to ask their Medicare patients about cost barriers and connect them with financial counselors who can help them understand their drug coverage and take advantage of these reforms,” Marinacci said. “If clinicians are not aware of this and do not communicate this to their patients, they can often withhold medications that they could have purchased had they known about this policy.”
Because the study was based on survey data, the researchers said it could be influenced by inconsistencies in how respondents self-reported their health status and medication adherence behaviors. Additionally, the study did not assess health outcomes, and Marinacci said future research could examine whether trends observed in medication adherence translate into improved health outcomes.
He said other data sources, such as pharmacy claims, could be used to assess the potential impact of catastrophic coverage changes on medication adherence. Additionally, he said it would be useful to consider subsequent policy changes regarding prescription drug costs after 2024 and assess the impact of those changes and how insurers are responding.
This study was funded by the National Institutes of Health.
The study was published online at the same time. jack At the time of the presentation.
Dr. Marinacci will present her research titled “Inflation Reduction Methods and Medication Adherence in Adults with Cardiovascular Disease: A Quasi-Experimental Policy Analysis” on Monday, March 30th at 9:30 am / 14:30 UTC at the Engage Stage of the Young Investigator Award Competition.
sauce:
American College of Cardiology
Reference magazines:
Marinacci, LX, others. (2026). Medication compliance among Medicare beneficiaries with cardiovascular disease after provisions of the Inflation Control Act of 2024. jack. DOI: 10.1016/j.jacc.2025.12.083. https://www.jacc.org/doi/10.1016/j.jacc.2025.12.083
