The Inflation Reduction Act and Patient Costs for Drugs to Treat Heart Failure

Introduction

The 2022 Inflation Reduction Act (IRA) contains several provisions to lower Medicare drug costs, including permitting the Centers for Medicare & Medicaid Services (CMS) to limit the prices of certain medicines and altering the standard Part D benefit to limit patient out-of-pocket costs. CMS has set the prices of 10 drugs effective 2026, including 3 commonly prescribed as part of combination therapy for heart failure (HF): dapagliflozin, empagliflozin, and sacubitril/valsartan. Dapagliflozin and empagliflozin also treat other conditions, including diabetes and chronic kidney disease.

One goal of the IRA is to reduce patient out-of-pocket liability; previous research has shown that the out-of-pocket cap will benefit patients taking HF drugs. However, the effect of eliminating the coverage gap phase has gotten less attention. Although previous legislation technically closed the coverage gap, patients still often faced mid-year out-of-pocket increases on branded drugs, with some reporting discontinuing their medication due to difficulty affording their prescriptions. Our study examines the pre-IRA out-of-pocket burden on Medicare patients taking these 3 drugs.

The full research letter is available in JAMA Network Open.

Trish, E. (2024). The Inflation Reduction Act and patient costs for drugs to treat heart failure. JAMA Network Open, 7(10), e2441915–e2441915. https://doi.org/10.1001/jamanetworkopen.2024.41915