The Inflation Reduction Act’s cap on annual out-of-pocket spending and changes to coverage gaps could save Medicare patients more than $1,000 on heart failure medications.
Heart failure drugs are expensive for Medicare patients; recommended regimens cost patients more than $2,500 per year. But Medicare patients can expect to save more than $1,000 on their heart failure medications under the Inflation Reduction Act, according to a research letter recently published in JAMA Cardiology.
“As a physician, few things are more frustrating than knowing there is a treatment that would improve or extend a patient's life, but they can’t afford it,” lead author Micah Johnson, M.D., resident physician at Brigham and Women’s Hospital, told Formulary Watch. “This happens all too often in heart failure, where guideline-recommended medications are extremely effective but out of reach for many patients.”
Johnson and his colleagues wanted to look at how out-of-pocket costs for heart failure medications in Medicare would be affected by the Inflation Reduction Act. In this study, they estimated out-of-pocket costs of medication regimens in Medicare Part D under current law and with the Inflation Reduction Act. Signed into law in August 2022, the Inflation Reduction Act adds a $2,000 cap on annual out-of-pocket spending and reforms the Part D benefit to eliminate the coverage gap.
Investigators assessed medication regimens that were constructed based on 2022 guidelines from American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guideline. They used list prices from the Part D Plan Finder in February 2022. Out-of-pocket costs were estimated using fourth-quarter 2021 Part D formulary files. Investigators then modeled a beneficiary without subsidies who faced the standard deductible and had no other drug spending. The IRA was modeled as if the law’s provisions were in full effect in 2022.
The recommended drug regimens can cost patients more than $2,500 per year under the current law. Investigators said this is because of high prices of two branded medications — Entresto (sacubitril/valsartan), an angiotensin receptor-neprilysin inhibitor (ARNI) and Jardiance (empagliflozin), a sodium-glucose cotransporter 2 inhibitor (SGLT2i) — the use of multiple medications, and the Part D coinsurance requirement in the coverage gap. But they found that under the Inflation Reduction Act, Medicare patients can expect to save more than $1,000 on their medications.
Heart failure, Johnson said, is a microcosm of a broader problem and patients with other chronic conditions such as diabetes, COPD, and cancer are facing the same problem with high out-of-pocket costs. “Patients who take additional costly medications for other conditions are likely to save even more," he said. "Overall, the Inflation Reduction Act is an important step toward making effective medications affordable for all patients.”
One limitation, investigators said, is that they made an assumption of no other medication use when calculating out-of-pocket costs. Savings, they said, could be greater for those taking other costly medications for comorbid conditions.