Originally published by our sister publication Specialty Pharmacy Continuum
By Myles Starr
The Inflation Reduction Act (IRA), which has made brand-name medications more affordable, also has yielded a key workflow benefit for pharmacists: They now need to rely less on patient assistance programs (PAPs) when shielding patients from the financial toxicity that can accrue from hematology, oncology and other high-cost medications.
The act was passed in August 2022, but new rules that went into effect on Jan. 1, 2024, offer even more prescription cost relief, noted Kristel Geyer, PharmD, a clinical coordinator at Cleveland Clinic, in Ohio. The new rules “include the removal of catastrophic copays for Medicare Part D and increased patient eligibility for low-income subsidies,” noted Dr. Geyer, who presented a study on the IRA (poster OPR61-OR) at the NASP 2024 Annual Meeting & Expo, in Nashville, Tenn. “With these changes, more patients can see the light at the end of the tunnel—that they will be able to afford their mediation.”
Dr. Geyer and her co-investigators conducted a retrospective analysis of PAP enrollment applications coordinated by the Cleveland Clinic Specialty Pharmacy (CCSP) for oncology and hematology medications between the first quarters of 2023 and 2024. In Q1 2023, the CCSP coordinated the enrollment of 163 patients in PAPs for hematology and oncology drugs with a cost savings of $2,866,341. By comparison, in Q1 2024, a total of 88 patients (–46%) were enrolled in PAPs, with a cost savings of $1,758,536 (–39%).
“Enrolling less patients in PAPs is a good thing because it means that more patients were going to be able to get their therapies and not need that extra support from our pharmacists,” Dr. Geyer explained. “Furthermore, when less money is needed from PAPs in total, this suggests that money set aside for grants can be distributed in smaller amounts and thus reach more patients.”
The researchers chose to analyze the effects of the IRA on patients taking oncology and hematology drugs, not just because of the drugs’ increasing use. Patients who were prescribed the medications had the best accompanying demographic data, including name, strength and dosage form of each medication; patient out-of- pocket cost; primary insurance type; and average wholesale price of drugs.
When parsing through the data, Dr. Geyer noted that most of the patients who needed copay assistance were Medicare recipients, highlighting that this population remains vulnerable to financial toxicity.
A yearly cap of $2,000 on out-of-pocket drug costs—part of the IRA—went into effect on Jan. 1, 2025. This rule change will benefit patients who are at continued risk for not being able to afford their medications and thus further decrease the need for PAP enrollment.
“I’m hopeful other institutions will be able to look more at [medication] persistence and abandonment rates, as well as the impact of the 2025 rule changes,” Dr. Geyer said. “I think that would help bring this whole picture into full circle.”
Dr. Geyer reported no relevant financial disclosures.