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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.
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.