PHILADELPHIA – While it may seem intuitive that people would die without life-saving medications, Penn and Harvard researchers have connected losing a federally funded prescription drug assistance program and an increase in mortality. The program, called the Medicare Part D Low-Income Subsidy (LIS), helps 14.2 million low-income Medicare beneficiaries, many of whom are older Americans, afford their medications. Nationally,12.5 million people who are eligible for and enrolled in both Medicare and Medicaid (“dual eligibles”) automatically qualify for the LIS, which is worth about $6,200/year.
The study, published today in New England Journal of Medicine by researchers at the University of Pennsylvania Perelman School of Medicine and Harvard T.H. Chan School of Public Health, reveals that losing Medicaid coverage—and with it, the LIS—was associated with significant increases in mortality among low-income Medicare beneficiaries.
“When Medicare beneficiaries lose Medicaid, which happens to more than 900,000 people each year, they also risk losing the LIS and therefore, being able to afford the medicines they need,” said lead author Eric T. Roberts, PhD, associate professor of General Internal Medicine at the University of Pennsylvania Perelman School of Medicine and a Leonard Davis Institute of Health Economics Senior Fellow.
Preserving Medicaid coverage for older adults saves lives
The study included nearly 1 million low-income Medicare beneficiaries whose Medicaid coverage ended. Due to program rules, the exact month people lose Medicaid impacts when they are removed from the LIS.
The researchers compared two groups: individuals who lost Medicaid from January to June who were removed from LIS by the following January (7–12 months later), and those who lost Medicaid from July to December lost LIS the next January (13–18 months later). This allowed the team to compare mortality rates during the period when some had lost LIS and others had not.
Mortality was 4 percent higher among individuals who lost the LIS earlier than those who retained it for a longer period. Over the study period, more than 2,900 people died. The risks were even greater among subgroups of people who had greater clinical needs and on more expensive medications. For example, mortality was 22 percent higher among people using HIV antiretroviral therapy.
The researchers found that over one half of individuals who lost Medicaid regained it within one year, suggesting that many were dropped from Medicaid despite remaining eligible.
“These findings show that helping low-income Medicare beneficiaries who are eligible for Medicaid stay enrolled and retain the LIS can save lives since it preserves access to essential medications,” said senior author José F. Figueroa, MD, MPH, an associate professor of health policy and management at Harvard Chan School.
The authors note that recent increases in Medicaid coverage losses among older adults raise concerns about potential losses of the LIS. Added Roberts, “As policymakers consider major changes to the Medicaid program, preserving Medicaid coverage for older adults is critical to ensuring that they keep the LIS.”
Support for this work comes from the National Institute on Aging (R01AG076437; R01AG081151; RF1AG088640; T32AG000037), the Agency for Healthcare Research and Quality (R01HS029453), and Arnold Venture.
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Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $580 million awarded in the 2023 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.
The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Doylestown Health, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
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Journal
New England Journal of Medicine
The IIflation Reduction Act (IRA), which included many changes to Medicare Part D prescription drug benefits, improved prescription drug affordability for many U.S. seniors, but also raised concerns that some insurers would exit the market. A new study from researchers at Mass General Brigham evaluates how many Medicare beneficiaries have been affected by those exits. In a paper published in JAMA, the research team reports that 2.9 million beneficiaries lost their Part D insurer between 2024 and 2025, marking a sharp increase compared to the six years prior.
“The reforms were designed to make Part D plans better for patients — including a $2000/year out-of-pocket cap for all patients,” said senior author Benjamin N. Rome, MD, MPH, of the Program On Regulation Therapeutics, and Law (PORTAL) at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “But these data suggest that millions of individuals who rely on Medicare prescription drug coverage could face disruptions by needing to select a plan from a different insurer.”
For their study, the authors examined data from the Centers for Medicare & Medicaid Services from 2018 through 2024. They found that from 2018 to 2023, 0.1% to 2.3% of beneficiaries lost their Part D insurer the subsequent year. But in 2024, 7.5% of beneficiaries lost their plan the following year. The authors note that loss of coverage could encourage patients to shop for better plans. But it could also lead to disruptions in coverage and medication adherence.
“These insurer exits will contribute to decreased competition, which may lead to decreased patient choice and eventually higher out-of-pocket costs,” said lead author Christopher L. Cai, MD, also of PORTAL. “Congress may need to take steps to stabilize the situation. This could include lowering the legal ceiling on annual deductibles, which is currently $590, or introducing a public Part D standalone option to promote competition.”
Authorship: In addition to Cai and Kesselheim, Mass General Brigham authors include Aaron Kesselheim and Anushka Bhaskar.
Disclosures: Cai reported receiving personal fees from Alosa Health outside the submitted work. Kesselheim reported receiving personal fees from Alosa Health; and serving as an expert witness for the Federal Trade Commission for a case relating to pharmacy benefit managers, for a group of state attorneys general and payors in a case related to alleged generic drug price fixing, and for a group of payors in a case against Johnson & Johnson related to the Stelara patent outside the submitted work. Rome reported receiving personal fees from Alosa Health outside the submitted work.
Funding: This study was funded by grants from the Commonwealth Fund and Arnold Ventures.
Paper cited: Cai, C. L. et al. “Insurer Exits After the Inflation Reduction Act Part D Redesign” JAMA DOI: 10.1001/jama.2025.7289
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About Mass General Brigham
Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations with several Harvard Medical School teaching hospitals. For more information, please visit massgeneralbrigham.org.
Article Title
Insurer Exits After the Inflation Reduction Act Part D Redesign
Article Publication Date
14-May-2025
Insurer exits after the Inflation Reduction Act Part D redesign
JAMA Network
About The Study:
In 2023 and 2024, more Part D beneficiaries were affected by their insurer exiting the marketplace than in previous years. This increase could be associated with changes to Medicare Part D from the Inflation Reduction Act (IRA), which increased Part D plan sponsor financial liability. These IRA provisions were designed to lower out-of-pocket costs for Part D beneficiaries, but increased Part D plan exits could lead to more limited coverage options and less competitive Part D marketplaces.
Corresponding Author: To contact the corresponding author, Christopher L. Cai, MD, email ccai@bwh.harvard.edu.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jama.2025.7289)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
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Media advisory: This study is being presented at the 2025 Society of General Internal Medicine Annual Meeting.
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