New Research Confirms Importance of Drug Affordability and Low Out-of-Pocket Costs

As we have highlighted in past articles, many people with Medicare—and many callers to our national consumer helpline—struggle to afford their care, especially medications. New research from Wakely emphasizes the importance of increasing affordability and access to medications, showing that when Medicare Advantage (MA) plans for people with low incomes eliminate copays for prescription medications, more of their enrollees take their drugs as prescribed.

Eliminating Copays Led to Greater Medication Adherence

Wakely studied enrollees of some MA Dual Eligible Special Needs Plans (D-SNPs)—a type of Medicare Advantage plan for people with both Medicare and Medicaid. Under a temporary experimental model, these plans chose to waive copayments for some or all prescription medications. The researchers found that enrollees with no copays had better medication adherence for diabetes, hypertension (high blood pressure), and high cholesterol medication, with diabetes medication showing the greatest improvement.

Findings Build on Previous Research

Historically, many policymakers wanted increased costs to dissuade people from using more care than they need. But some of this thinking is changing as more data come in, and Wakely’s findings corroborate earlier research showing that people facing higher out-of-pocket costs for health care cut back on the care they receive, even if it is necessary for their health and safety.

Studies show that “the greater the cost-sharing, the worse the medication adherence,” leading to worse health, higher care needs, and more hospitalization.

Studies show that “the greater the cost-sharing, the worse the medication adherence,” leading to worse health, higher care needs, and more hospitalization. It also costs more. By contrast, eliminating copays does not increase costs and may save money in the long run by preventing the need for more acute care.

Increasing Threats to Affordability and Financial Stability

These findings come amidst news of rising medical debt, the Trump administration “deprioritizing” consumer protections for such debt, a burgeoning market for medical credit cards, and Congressional proposals to slash Medicaid and other programs for people with limited resources. Drug price negotiation from the Inflation Reduction Act (IRA) is also at risk of legislative and administrative changes, despite new polling that shows most voters continue to support and want Congress to expand on the IRA’s drug reforms rather than limit them.

At Medicare Rights, we know that out-of-pocket costs can derail access to care and harm people’s health. We urge Congress and other policymakers to reduce the financial burden of health care and coverage through Medicare and other insurance.

Take Action Now!

Members of Congress are currently home for a two-week recess through Sunday, April 27. Now is the time to remind them that their votes have consequences, and that a reconciliation bill would harm their constituents, district, and state. Learn more and act today.

Further Reading

Read the Wakely study.

Read more about recent polling on drug prices.

Read more about threats to drug price negotiation.

Read more about proposed Medicaid and other cuts.