Federal drug price reforms are improving medication adherence, new study finds

More than 1 in 4 U.S. adults struggle to afford their prescription medications. Those who can’t are left with grim choices—such as skipping doses, cutting pills in half, or abandoning prescriptions entirely—that can come with serious health consequences.

Federal drug pricing reforms intended to improve medication affordability are beginning to help, according to new research led by Harvard Medical School researchers in the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center.

Published in JAMA Internal Medicine, the study found that Medicare beneficiaries were less likely to report skipping, rationing, or foregoing medications due to cost after the Inflation Reduction Act‘s prescription drug cost-cutting provisions took effect Jan. 1, 2024. Before this study, researchers did not know whether the Act was affecting cost-related medication adherence.

The improvement was greatest among those managing multiple chronic conditions.

“For too long, Medicare patients have been forced to ration important medications because of cost. Our findings are an early signal that the Inflation Reduction Act is changing that—and the patients benefiting most are exactly those who need it most,” said senior author Rishi Wadhera, HMS associate professor of medicine at Beth Israel Deaconess and associate director and section head of health policy research at the center.

The team also found, however, that while the Act’s drug provisions are helping Medicare beneficiaries stay on their medications, they are not yet making a dent in their overall health care costs. The study found neither a corresponding improvement in beneficiaries’ ability to pay medical bills nor a decrease in their anxiety about future health care costs.

Study details

The Inflation Reduction Act’s 2024 provisions targeted two groups most burdened by drug costs:

• For Medicare beneficiaries with high medication spending, the law eliminated the 5 percent coinsurance requirement for catastrophic coverage, effectively capping annual out-of-pocket costs at approximately $3,300 per year.
• For lower-income enrollees who had been receiving only partial assistance, it expanded access to full subsidies, significantly reducing what they pay for their medications.

To assess the real-world impact of these changes, Wadhera and colleagues used a quasi-experimental difference-in-differences design, drawing on data from the National Health Interview Survey—an annual survey of about 27,000 U.S. adults conducted by the Centers for Disease Control and Prevention.

Wadhera and colleagues compared Medicare Part D beneficiaries between the ages of 62 and 67 to a similar group of privately insured adults who were not subject to the Act’s provisions.

Who benefits most

The team found that during their first year of eligibility, Medicare beneficiaries experienced a 4.9 percentage point reduction in cost-related medication nonadherence relative to their privately insured counterparts. Specifically, fewer patients reported skipping doses, reducing doses, delaying prescription fills, or foregoing medications because of cost.

The finding held up across multiple sensitivity analyses, including after adjusting for race, ethnicity, income, and educational attainment and when compared to a different group (dually enrolled beneficiaries).

The effect was particularly pronounced among beneficiaries managing two or more chronic conditions, including hypertension, diabetes, heart disease, and cancer. This group saw a 7.8 percentage point reduction in cost-related nonadherence.

For privately insured adults, not covered by the Act’s provisions, medication nonadherence rose more than 2 percentage points during the same period.

“When someone with diabetes or heart disease stops taking their medications due to cost, the consequences can be severe,” said first author Lucas Marinacci, a cardiologist and HMS instructor in medicine at Beth Israel Deaconess and faculty physician investigator at the center. “Our data suggest that the IRA’s reforms are helping the highest-risk patients stay on the medications they need.”