The Inflation Reduction Act and Out-of-Pocket Drug Costs for Medicare Beneficiaries With Cardiovascular Disease

Dhruv S Kazi; Colette DeJong; Randi Chen; Rishi K Wadhera; Chien-Wen Tseng

doi:10.1016/j.jacc.2023.03.414

The Inflation Reduction Act and Out-of-Pocket Drug Costs for Medicare Beneficiaries With Cardiovascular Disease

J Am Coll Cardiol. 2023 May 30;81(21):2103-2111. doi: 10.1016/j.jacc.2023.03.414.

Authors

Dhruv S Kazi¹, Colette DeJong², Randi Chen³, Rishi K Wadhera⁴, Chien-Wen Tseng⁵

Affiliations

¹ Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: dkazi@bidmc.harvard.edu.
² Division of Cardiology, University of California San Francisco, San Francisco, California, USA. Electronic address: https://twitter.com/colettedejong.
³ Department of Research, Kuakini Medical Center, Honolulu, Hawaii, USA.
⁴ Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: https://twitter.com/rkwadhera.
⁵ Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA; Pacific Health Research and Education Institute, Honolulu, Hawaii, USA.

PMID: 37225364
DOI: 10.1016/j.jacc.2023.03.414

Abstract

Background: High out-of-pocket costs can impede access to guideline-directed cardiovascular drugs. The 2022 Inflation Reduction Act (IRA) will eliminate catastrophic coinsurance and cap annual out-of-pocket costs for Medicare Part D patients by 2025.

Objectives: This study sought to estimate the IRA's impact on out-of-pocket costs for Part D beneficiaries with cardiovascular disease.

Methods: The investigators chose 4 cardiovascular conditions that frequently require high-cost guideline-recommended drugs: severe hypercholesterolemia; heart failure with reduced ejection fraction (HFrEF); HFrEF with atrial fibrillation (AF); and cardiac transthyretin amyloidosis. This study included 4,137 Part D plans nationwide and compared projected annual out-of-pocket drug costs for each condition in 2022 (baseline), 2023 (rollout), 2024 (5% catastrophic coinsurance eliminated), and 2025 ($2,000 cap on out-of-pocket costs).

Results: In 2022, mean projected annual out-of-pocket costs were $1,629 for severe hypercholesterolemia, $2,758 for HFrEF, $3,259 for HFrEF with AF, and $14,978 for amyloidosis. In 2023, the initial IRA rollout will not significantly change out-of-pocket costs for the 4 conditions. In 2024, elimination of 5% catastrophic coinsurance will lower out-of-pocket costs for the 2 costliest conditions: HFrEF with AF ($2,855, 12% reduction) and amyloidosis ($3,468, 77% reduction). By 2025, the $2,000 cap will lower out-of-pocket costs for all 4 conditions to $1,491 for hypercholesterolemia (8% reduction), $1,954 for HFrEF (29% reduction), $2,000 for HFrEF with AF (39% reduction), and $2,000 for cardiac transthyretin amyloidosis (87% reduction).

Conclusions: The IRA will reduce Medicare beneficiaries' out-of-pocket drug costs for the selected cardiovascular conditions by 8% to 87%. Future studies should assess the IRA's impact on adherence to guideline-directed cardiovascular therapies and health outcomes.

Keywords: cardiovascular disease; economics; heart failure; nonadherence; out-of-pocket costs.

MeSH terms

Aged
Amyloid Neuropathies, Familial*
Atrial Fibrillation*
Cardiovascular Diseases* / drug therapy
Drug Costs
Health Expenditures
Heart Failure* / drug therapy
Humans
Hypercholesterolemia*
Medicare
Stroke Volume
United States / epidemiology

Supplementary concepts

Amyloidosis, Hereditary, Transthyretin-Related