BIDEN REFORM
Fewer seniors with heart disease report skipping meds after Medicare reforms
Survey shows less cost-related medication rationing after Inflation Reduction Act took effect in 2024
American College of Cardiology
Medicare beneficiaries with heart disease or major cardiovascular risk factors reported less cost-related medication non-adherence—skipping or reducing doses, delaying prescription fills or foregoing medications due to cost—after new provisions went into effect limiting out-of-pocket drug costs for Medicare beneficiaries, according to a study being presented at the American College of Cardiology’s Annual Scientific Session (ACC.26) and simultaneously published in JACC, the flagship journal of the ACC.
The study focuses on impacts from two provisions of the 2022 Inflation Reduction Act (IRA) that took effect January 1, 2024. Researchers compared survey data from 2024 against prior years to analyze trends in self-reported medication non-adherence among older adults with heart disease or major cardiovascular risk factors.
“In the low-income group, we saw a pretty big benefit—it really helped people afford their medications,” said 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. “Our findings suggest that the 2024 IRA provisions supported better medication adherence, and better adherence may translate into better health.”
Heart disease is the leading cause of death worldwide. Newer drug classes like GLP-1 receptor agonists, SGLT2 inhibitors and novel anticoagulants have grown in prominence alongside conventional cholesterol and blood pressure-lowering medications for reducing the risk of serious cardiac events among people with conditions like atrial fibrillation, heart failure or a history of heart attack or stroke. However, the combination of these medications can be expensive, and prior studies have shown that patients sometimes do not take medications as prescribed if they feel they cannot afford them.
The policy changes that went into effect January 1, 2024, included two provisions intended to make prescription drugs more affordable for Medicare beneficiaries. One provision expanded eligibility for “extra help” subsidies, which 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.
Researchers used data from the National Health Interview Survey, a nationally representative survey of U.S. adults, to analyze trends in medication non-adherence among respondents reporting a history of coronary heart disease, angina (chest pain or tightness), 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 cost (cost-related medication non-adherence) and whether they worried about or were unable to pay their medical bills (health care-related financial strain). To analyze changes related to the new Medicare provisions, researchers compared survey responses from 2024 with responses from 2021-2023.
In one analysis, researchers compared responses from 4,710 Medicare beneficiaries aged 65 years and older with incomes below 135% of the federal poverty level (who were eligible for “extra help” subsidies before 2024) and 923 beneficiaries with incomes between 135% and 150% of the federal poverty level (who were newly eligible for the full subsidies starting in 2024). The results showed a significant 5.5 percentage point decrease in reported cost-related medication non-adherence among beneficiaries who were newly eligible for the subsidies.
In another analysis, researchers compared responses from 25,522 Medicare beneficiaries aged 65 years or older with a control group of 5,332 privately insured respondents aged 60-64 years. They found that cost-related medication non-adherence dropped by 2.1 percentage points among Medicate beneficiaries compared with the control group. This trend held true even after adjusting for income, race and ethnicity, employment status and educational attainment. There was no change in health care-related financial strain.
A third analysis examined responses from Medicare beneficiaries with incomes above 150% of the federal policy level and those with incomes below 135% of the federal poverty level. That analysis did not show a significant difference in medication non-adherence between these groups.
Based on the results, researchers estimated 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 that went into effect that year. This provides early evidence that the Medicare reforms had a meaningful benefit in terms of reducing medication non-adherence, which they said is likely to translate into better health outcomes for some patients. Researchers said that making similar changes to reduce out-of-pocket drug costs for people with other types of health insurance, such as Medicaid or private insurance, could also have similar effects.
However, researchers said that patients are only likely to change their behavior in response to policy changes if they are aware of what those changes mean for them. Since many seniors struggle to understand their health coverage—for example, some Medicare beneficiaries may be unaware that their total out-of-pocket costs are now capped under the IRA—Marinacci said that clinicians need to play an active role in helping patients understand that their medications may be more affordable than they think.
“Cardiology providers should continue asking Medicare patients about cost barriers and connecting them to financial counselors who can help them understand their drug coverage and take advantage of these reforms,” Marinacci said. “If clinicians aren’t aware of this and don’t tell their patients, oftentimes people may forego medications that they could otherwise afford if they were aware of the policy.”
Since the study is based on survey data, researchers said that it may be affected by inconsistencies in how respondents self-reported their health conditions or medication adherence behavior. In addition, the study did not assess health outcomes, and Marinacci said that future studies could examine whether the observed trends in medication adherence translate into improved health outcomes.
He said that other data sources such as pharmacy claims could be used to evaluate the potential impacts of the change in catastrophic coverage on medication adherence. In addition, in light of subsequent changes in policy related to prescription drug costs that have occurred since 2024, he said it would be useful to assess the impacts of those changes and the ways insurers respond to them.
The study was funded by the National Institutes of Health.
This study was simultaneously published online in JACC at the time of presentation.
Marinacci will present the study, “The Inflation Reduction Act and Medication Adherence Among Adults with Cardiovascular Conditions: A Quasi-Experimental Policy Analysis,” on Monday, March 30, at 9:30 a.m. / 14:30 UTC at the Engage Stage for the Young Investigators Award Competition.
ACC.26 will take place March 28-30, 2026, in New Orleans, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC26 for the latest news from the meeting.
The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family of JACC Journals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart.org patient resources and more, the College is committed to ensuring a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at ACC.org.
###
Journal
Journal of the American College of Cardiology
Article Title
Medication Adherence Among Medicare Beneficiaries With Cardiovascular Conditions After the 2024 Inflation Reduction Act Provisions
Article Publication Date
24-Mar-2026
.jpg)
