Could the Inflation Reduction Act Maximum Fair Price Hurt Patients?

Area of Science:

• Health Economics and Policy
• Pharmaceutical Management
• Patient Outcomes Research

Background:

• The Inflation Reduction Act's Medicare Drug Price Negotiation Program enables government negotiation of drug prices.
• Pharmacy benefit managers (PBMs) may face revenue pressure from these price caps.
• PBMs might shift costs to patients by increasing out-of-pocket expenses for capped medications.

Purpose of the Study:

• To model the financial and clinical impact of increased out-of-pocket costs for apixaban and rivaroxaban.
• To evaluate potential patient treatment abandonment and subsequent morbidity and mortality.
• To assess the downstream effects of the Medicare Drug Price Negotiation Program on patient costs.

Main Methods:

• Utilized 2023 prescription fill data from major PBMs for apixaban and rivaroxaban.
• Modeled increased out-of-pocket costs by shifting prescriptions to the highest copay tier.
• Calculated treatment abandonment rates based on copay increases and estimated morbidity/mortality.

Main Results:

• A shift to the highest copay tier could increase patient costs by $482 million for apixaban and $206 million for rivaroxaban.
• This could lead to 169,000–228,000 patients abandoning apixaban and 71,000–93,000 abandoning rivaroxaban.
• Estimated increases include up to 145,000 major cardiovascular events and 97,000 additional deaths.

Conclusions:

• The Medicare Price Negotiation Program may negatively impact patients if PBMs increase out-of-pocket drug costs.
• Policymakers must monitor overall medication affordability and patient expenditures.
• Proactive measures are needed to protect vulnerable populations from adverse health outcomes.