November 15, 2023

Additional analysis finds Medicare reforms may lead to more patients starting treatment in 2025

The PAN Foundation, a leading charitable patient assistance organization, today announced additional findings that explore the number of Medicare Part D beneficiaries who will begin treatment and other potential impacts of the historic reforms included in the 2022 Inflation Reduction Act (IRA).

The analysis, conducted by Avalere and sponsored by PAN, points to an increase in new users starting therapy across six of the eight therapeutic areas analyzed, ranging from a 6 to 86 percent increase. Once again, this study explored potential behavior changes in 2025 among non-low-income subsidy patients taking medications within eight key therapeutic areas—asthma and COPD, autoimmune diseases, blood thinners, cancer, diabetes (non-insulin), eye medications, HIV, and multiple sclerosis. This analysis also assumes conservative, or low level, estimates of beneficiary utilization and plan formulary management responses.

This new study follows recent analysis from Avalere that looked at the projected behavior change among existing users within the same eight therapeutic areas. When looking at both existing and new users, some key findings include:

Over one million Medicare beneficiaries may newly start prescription drug therapies

More patients will be newly starting treatment as a result of the Medicare Part D reforms. Avalere estimates that anywhere from 6 to 86 percent more Medicare beneficiaries across the eight therapeutic areas analyzed will be able to newly start treatment in 2025. The increase in beneficiaries taking prescription drugs were most notable in the following therapeutic areas:

Autoimmune diseases: 86 percent increase (approximately 65,000 new patients)
Asthma and COPD: 23 percent increase (approximately 1,000,000 new patients)
Eye medications: 8 percent increase (approximately 300,000 new patients)
HIV: 8 percent increase (approximately 4,300 new patients)

More patients will be able to adhere to treatment

Avalere projects the number of 30-day prescriptions for drugs within the eight therapeutic areas examined to increase between 2 to 28 percent following implementation of the 2025 reforms, indicating that many more patients living with these conditions will be able to adhere to their prescribed treatment. Some of the most notable increases in 30-day prescriptions include:

Asthma and COPD: 28 percent increase
Eye medications: 23 percent increase
Autoimmune diseases: 12 percent increase
Cancer: 10 percent increase

However, if plans are more restrictive in their formulary management response, uptake and adherence may be limited.

Read findings from part one

“While it’s exciting to see this analysis point to more patients who will likely start on treatments due to the historic Medicare Part D reforms going into effect in 2025, we know that’s not the full story,” said Kevin L. Hagan, President and CEO of the PAN Foundation. “This analysis, along with previous polling and research, highlight that far too many patients will continue to face affordability challenges, even with these new reforms in place. And with more patients enrolled in Medicare Part D starting treatment, the need for charitable patient assistance from the PAN Foundation will continue—and we’ll be there to support them.”

The impending Medicare Part D reforms will make it possible for potentially more than one million patients to start and stay on the therapies they need to manage their life-threatening, chronic, or rare disease. However, it’s clear that affordability challenges will persist for many. And when faced with high out-of-pocket costs, many patients choose to delay or go without their prescribed medications—unless they receive financial support from the PAN Foundation. Through its more than 70 disease funds, PAN is committed to continuing to help patients access the treatment and medications they need and deserve.

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 1.1 million underinsured patients with $4 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. 