Medicare Patients' Health Care Access Impacted by Changes in 2024 Plan Offerings

Influential shifts within 2024 Medicare Part D plans are shifting access and affordability for Medicare beneficiaries, according to a new analysis from Avalere. Notably, the report revealed decreases in the amount of low-income subsidy (LIS) benchmark plans and standalone prescription drug plans (PDPs) since 2023, coinciding with increases in Part D premiums for PDPs. Patients enrolled across either plan may need to anticipate consequences that affect the coverage, access, and affordability of prescription drugs.¹

The analysis, conducted by Avalere and sponsored by PAN Foundation, compared the observable changes between PDP formularies from 2023 to 2024, including coverage that remained available both years, the 2023 formularies no longer on the market, and the 2024 formularies for the plans that have remained available. Additionally, Avalere evaluated differences between the 2023-2024 LIS PDP formularies that held benchmark status by comparing the 2024 LIS PDP formularies that lost their benchmark status from the previous year with those that kept their status in 2024. In addition, 24 of the most used, single-source brand drugs were assessed throughout 5 medicinal areas: pulmonary hypertension (PH), multiple sclerosis (MS), autoimmune disorders, asthma or chronic obstructive pulmonary disease (COPD), and anticoagulants.

Health care plan changes in 2024 will impact the access and affordability of prescription medications for Medicare patients | image credit: Vitalii Vodolazskyi - stock.adobe.com

In 2024, 95 of the 801 PDPs offered in 2023 are no longer available—signifying a 12% decrease in available PDPs that impacts approximately 400,000 enrollees. Coverage for the included MS and anticoagulant drugs was relatively unaffected, coverage of autoimmune and asthma/COPD drugs increased in 2024 (96% vs 92% and 82% vs 86%), and PH drug coverage decreased (30% vs 39%). The researchers noted that beneficiaries affected by PH experienced the biggest hit in coverage options if their 2023 PDP was taken off the market compared with beneficiaries in the other areas. Additionally, for plans that stayed on the market in 2024, 13 PDP regions had a 5 percentage point increase in their coverage of MS medication; however, 11 PDP regions saw a 5 percentage point decrease in MS drug coverage as some 2023 plans were removed from the market.

The use of coinsurance also increased, which the researchers attributed to an uptick in PDPs’ including coinsurance on their 2024 preferred brand tier, as opposed to making alterations in tier placement. For example, from 2023-2024, coinsurance use grew by 26 percentage points for anticoagulants and 31 percentage points for asthma/COPD medication.

Of note was the significant decline in LIS benchmark plans, which decreased from 191 to 119 plans. Benchmark status was revoked for 60 plans, impacting an estimated 3.2 million enrollees (47% of those with LIS benchmark plans) who were then charged a premium after opting into a new 2024 plan. For the plans that kept their benchmark status in 2024, enrollees had fairly stable or high coverage across LIS PDPs, with MS medication coverage increasing by 3 percentage points; yet PH medication coverage dropped by 8 percentage points and autoimmune medication coverage by 5 percentage points.

Overall, although some of these shifts appear to be minimal, the authors emphasized how year-to-year changes in formularies or plan offerings could have a great effect on access for different patient populations depending on where they live or the medications they need.

“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,” Kevin L. Hagan, president and CEO of the PAN foundation, said in a statement.²

Last week, CMS unveiled the new negotiated drug prices for the first 10 drugs being negotiated under the Inflation Reduction Act with negotiated prices ranging from 38% below list price to a much as 79% below list price.³

It is likely that additional changes influencing patient benefits and plan formularies will come in 2025. “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,” Hagan emphasized.

References

1. Formulary Coverage and Access Shifts in 2024 PDPs. Avalere. August 20, 2024. Accessed August 20, 2024. https://avalere.com/insights/formulary-coverage-and-access-shifts-in-2024-pdps?Email=kmunz%40ajmc.com&insightCategory=Coverage+and+Payment&DNUSalutation=&formid=1024&munchkinId=158-LUO-793

2. Analysis reveals changes in 2024 healthcare plans impact access for Medicare patients. PAN Foundation. News Release. August 20, 2024. Accessed August 20, 2024. https://www.panfoundation.org/analysis-reveals-changes-in-2024-healthcare-plans-impact-access-for-medicare-patients/

3. Santoro C. Lower drug prices announced under Medicare negotiation program. AJMC^®. August 15, 2024. Accessed August 20, 2024. https://www.ajmc.com/view/lower-drug-prices-announced-under-medicare-negotiation-program