Cost-related medication non-adherence declined after the Inflation Reduction Act
A policy limiting out-of-pocket drug costs for Medicare beneficiaries implemented in 2024 appears to have increased medication compliance, according to a new study presented at the 2026 American College of Cardiology (ACC) and published in the JACC.[1]
The 2022 Inflation Reduction Act (IRA) took effect Jan. 1, 2024. The law was designed to curb inflation through several actions to reduce the federal deficit, including two provisions to make prescription drugs more affordable for Medicare beneficiaries. One provision expanded eligibility for drug subsidies to reduce drug co-payments 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. A separate provision eliminated the 5% coinsurance requirement for catastrophic coverage, essentially capping the amount a person will spend on out-of-pocket drug costs.
To analyze the impact of these policies, researchers in this National Institutes of Health funded study used data from the National Health Interview Survey to assess medication non-adherence among respondents with a history of coronary heart disease, angina, heart attack, stroke, transient ischemic attack, high blood pressure, high cholesterol, diabetes or obesity.
Survey questions asked participants whether they had skipped, reduced, delayed or foregone doses of their prescribed medications due to the cost of drugs and if they worried about or were unable to pay their medical bills. To analyze changes related to the new Medicare provisions, researchers compared survey responses from 2024 with responses from 2021-2023.
The responses showed less cost-related medication non-adherence, including skipping or reducing doses, delaying prescription fills or foregoing medications due to cost after the law went into effect.
“In the low-income group, we saw a pretty big benefit, it really helped people afford their medications,” Lucas Marinacci, MD, a physician at Beth Israel Deaconess Medical Center, a faculty member at the Richard A. & Susan F. Smith Center for Outcomes Research in Boston, and the study’s lead author, said in a statement. “Our findings suggest that the 2024 IRA provisions supported better medication adherence, and better adherence may translate into better health.”
The study authors estimated the reductions in drug costs meant 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. The study provides early evidence that the Medicare reforms did have a meaningful impact in terms of reducing medication non-adherence. Researchers said that making similar changes to reduce out-of-pocket drug costs for patients with Medicaid and private insurance could also have similar effects.
The data show a significant 5.5 percentage point decrease in reported cost-related medication non-adherence among beneficiaries who were newly eligible for the subsidies.
An analysis comparing responses from 25,522 Medicare beneficiaries with a control group of 5,332 privately insured respondents aged 60-64 years found cost-related medication non-adherence dropped by 2.1% among Medicare beneficiaries compared with the control group, even though there was no change in health care-related financial strain. The authors said this trend was maintained even after adjusting for income, race and ethnicity, employment status and educational attainment. There was no change in health care-related financial strain.
This data is important for assessing Medicare patient adherence for newer and more expensive drug classes, like GLP-1 receptor agonists, SGLT2 inhibitors and novel anticoagulants. While prescribing the drugs has increased, the combination of these medications can be expensive and prior studies showed patients sometimes did not take medications as prescribed if they felt they could not afford them.
However, since many Medicare patients struggle to understand their health coverage, they are often unaware that their total out-of-pocket costs are now capped under the IRA, Marinacci explained. He said clinicians need to play a more active role in helping patients understand that medications are now more affordable, because patients are only likely to change their behavior in response to policy changes if they are aware of what the changes mean for them.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]