ADVI Expert Caitlin Sheetz Discusses IRA Implications at ISPOR

 Caitlin Sheetz, ADVI solution leader for Strategic Analytics, Value and Economics (SAVEs), presented four poster presentations at ISPOR 2024. One of the studies analyzed patient cost and demographics among the first ten drugs subject to price negotiation under the Inflation Reduction Act (IRA).

The study’s primary objective was to analyze patients taking one of the first ten drugs subject to price negotiation and understand their demographics, prescription drug utilization, out of pocket costs and how that compared to the rest of the Part D population.

This analysis was done on 100 percent Medicare Part D event data and Medicare Beneficiary Summary File from 2022.

The study identified over 7.7 million patients taking one of the top 10 drugs and found that they are:

• Older and have higher proportions of males, low-income subsidy, and higher HCC risk scores compared to the rest of the Part D population.
• On average, these patients take more medications (13 unique drugs) compared to other Part D beneficiaries (8.3 unique drugs).
• About 40 percent of the patients taking these 10 drugs are LIS, and three products in the immunosuppressant and molecular targeted therapy classes have greater than 50 percent LIS population.
• When analyzing OOP costs across all medications, three of the top 10 drugs account for >80 percent of non-LIS patients’ total liability, while the remaining seven only account for 20-50 percent of their OOP costs.

Hear more from Caitlin as she sheds light on key insights from the study and takeaways from ISPOR 2024.

This analysis demonstrates that the initial patient population taking drugs subject to price negotiation look different in demographic makeup and the volume of prescription drugs that they take compared to the rest of the Part D population. As this and other IRA provisions, like the $2,000 OOP CAP, are implemented, it will be important to monitor prescription drug behavior and the impact that these policies are having on Part D beneficiaries.

Learn More

ADVI experts will continue to analyze trends in the claims data throughout the implementation of the Inflation Reduction Act (IRA). Get in touch today to gain expert insights on the IRA and the evolving healthcare landscape.

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Caitlin Sheetz, MPH
Senior Vice President and Head of Strategic Analytics, Value and Economics