Analysis reveals changes in 2024 healthcare plans impact access for Medicare patients
The PAN Foundation, a leading charitable assistance foundation and healthcare advocacy organization, today announced new findings that highlight the formulary coverage and access shifts facing patients enrolled in standalone prescription drug plans (PDPs) and low-income subsidy (LIS) benchmark plans, including changes in premiums and plan offerings.
The analysis, conducted by Avalere and sponsored by PAN as part of its Center for Patient Research, found that 12 percent of PDPs offered in 2023 were not available in 2024, impacting about 400,000 enrollees. In addition, 31 percent of 2023 PDPs lost LIS benchmark status in 2024, representing 3.2 million LIS benchmark plan enrollees—causing them to have to either choose a new plan or pay a premium in 2024.
Building upon Avalere’s previous research with PAN, this new study evaluates the impact of PDP and LIS benchmark plan market changes from 2023 and 2024. The analysis focuses on 24 of the most commonly used, single-source brand drugs across five key therapeutic areas, including anticoagulants, asthma/chronic obstructive pulmonary disease (COPD), autoimmune, multiple sclerosis, and pulmonary hypertension.
Key findings
Formulary coverage was lower for drugs in some therapeutic areas examined, while remaining the same or increasing in others.
For plans available in both 2023 and 2024, coverage in PDP formularies in 2024 when compared to 2023 was substantially lower for top pulmonary hypertension drugs (9 percentage point decrease) and was slightly lower for multiple sclerosis drugs (1 percentage point decrease).
Drugs in other therapeutic areas examined either saw no change or an increase in coverage (anticoagulant drugs – 0 percentage point change; asthma/COPD drugs – 4 percentage point increase; autoimmune drugs – 4 percentage point increase).
Patients in some key therapeutic areas examined saw a substantial increase in the use of coinsurance.
While use of coinsurance was unchanged for autoimmune drugs, multiple sclerosis drugs, and pulmonary hypertension drugs, use of coinsurance increased substantially for anticoagulant drugs (26 percentage point increase in 2024 when compared to PDPs available in 2023) and asthma/COPD drugs (31 percentage point increase in 2024 when compared to PDPs available in 2023).
The increased use of coinsurance was largely driven by more PDPs implementing coinsurance on the preferred brand tier, rather than due to changes in tier placement.
When examining changes between 2024 PDPs that remained in the market compared to 2023 PDPs that exited, some substantial national and regional changes were uncovered among drugs in therapeutic areas examined.
Relative to 2023 PDPs that exited, coverage was lower in 2024 PDPs that remained in the market for pulmonary hypertension drugs (6 percentage point decrease), while other therapeutic areas examined experienced either no change or slight increases in coverage: anticoagulant drugs (0 percentage point change); asthma/COPD drugs (2 percentage point increase); autoimmune drugs (2 percentage point increase); and multiple sclerosis drugs (2 percentage point increase).
For plans that remained in the market in 2024, coverage for multiple sclerosis drugs was higher by at least 5 percentage points in 13 PDP regions and lower by at least 5 percentage points in 11 PDP regions, when compared to 2023 plans that exited the market.
For plans that remained in the market in 2024, coverage for pulmonary hypertension drugs was higher by at least 5 percentage points in only 2 PDP region and lower by at least 5 percentage points in 21 of the 34 PDP regions, when compared to 2023 plans that exited the market.
Use of coinsurance for anticoagulant drugs and asthma/COPD drugs increased 30 percentage points for plans that remained in the market in 2024, when compared to 2023 plans that exited the market. Coinsurance use remained the same for autoimmune drugs, multiple sclerosis drugs, and pulmonary hypertension drugs.
Certain therapeutic areas examined face more substantial regional variation in utilization management changes.
When comparing PDPs that lost benchmark status with 2024 LIS PDPs that maintained benchmark status, there were few national differences in use of UM (including prior authorization and step therapy). However, there were substantial regional differences for anticoagulant drugs.
In five regions, there was at least a 20-percentage point difference in UM among plans that lost benchmark status compared to plans that maintained benchmark status.
Medicare reforms have great promise, while patients still face challenge with healthcare access and affordability
“While the Medicare Part D reforms included in the Inflation Reduction Act have great promise, this analysis reinforces the access and affordability challenges that will continue to face patients across the country,” said Kevin L. Hagan, President and CEO of the PAN Foundation. “And we know that in 2025, when the remaining reforms go into effect and shift more cost liability to plans, patients may likely face even more changes to plan formulary and benefit offerings. This research by Avalere once again helps to quantify the extent of the ongoing need for charitable patient assistance foundations like PAN to help people access and afford their much-needed care.”
When individuals with life-threatening, chronic, and rare diseases face high out-of-pocket healthcare costs—whether through coinsurance, premiums, or others means—far too many choose to delay or go without their prescribed medications. That’s why PAN will continue to play a critical role for thousands of patients across the country each year. By helping them with their out-of-pocket costs for prescription medications and health insurance premiums, PAN allows these patients to focus on what matters most—receiving the treatment and care they need and deserve.
PAN also continues to lead the way in advocating for improved healthcare access, affordability, and equity for all. In addition, PAN is committed to equipping people with the educational resources they need to better understand complex healthcare topics, including the new Medicare Part D reforms. In fact, PAN’s award-winning Medicare reforms educational hub has been accessed by over 70,000 visitors. Learn more about the work of the PAN Foundation at panfoundation.org.
Further resources
About the PAN Foundation
The PAN Foundation is an independent, national 501 (c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic, and rare diseases with the out-of-pocket costs for their prescribed medications.
Since 2004, we have provided more than 1.2 million underinsured patients with $4.5 billion in financial assistance. Partnering with generous donors, healthcare providers and pharmacies, we provide the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life. Learn more at panfoundation.org.