{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:11:02Z","timestamp":1755216662704,"version":"3.43.0"},"reference-count":37,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"2","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["jheor.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"background\"> <jats:title>Background<\/jats:title> <jats:p>The Inflation Reduction Act\u2019s Medicare Drug Price Negotiation Program allows the federal government to negotiate caps for select medications. These price caps may reduce revenue for the pharmacy benefit managers (PBMs) that negotiate the actual price paid for medicines in the U.S. To offset the resulting pressure on their profit margins, it is possible that PBMs would, in turn, increase patients\u2019 out-of-pocket costs for medicines with capped prices. The model presented here evaluates how increased out-of-pocket costs for the anticoagulants apixaban (Eliquis) and rivaroxaban (Xarelto) could impact patients financially and clinically.<\/jats:p> <\/jats:sec> <jats:sec id=\"methods\"> <jats:title>Methods<\/jats:title> <jats:p>Copay distributions for all 2023 prescription fills for apixaban and rivaroxaban managed by the 3 largest PBMs, CVS Caremark, Express Scripts International, and Optum Rx, were used to approximate current copay costs. Increased out-of-pocket costs were modeled as a shift of all apixaban and rivaroxaban prescriptions to the highest copay tier. The known linear relationship between copay costs and treatment abandonment was used to calculate the potential resulting increase in treatment abandonment. Known rates of morbidity and mortality due to abandoning anticoagulants were used to estimate resulting increases in morbidity and mortality.<\/jats:p> <\/jats:sec> <jats:sec id=\"results\"> <jats:title>Results<\/jats:title> <jats:p>If the 3 largest PBMs all shifted costs onto patients by moving all apixaban and rivaroxaban prescriptions to the highest formulary tier, Tier 6, patients\u2019 copay amount would increase by $235 to $482 million for apixaban and $105 to $206 million for rivaroxaban. Such an increase could lead to 169\u2009000 to 228\u2009000 patients abandoning apixaban and 71\u2009000 to 93\u2009000 abandoning rivaroxaban. The resulting morbidity and mortality could include up to an additional 145\u2009000 major cardiovascular events and up to 97\u2009000 more deaths.<\/jats:p> <\/jats:sec> <jats:sec id=\"conclusion\"> <jats:title>Conclusion<\/jats:title> <jats:p>The Medicare Price Negotiation Program could impact patients negatively if it causes PBMs to increase patients\u2019 out-of-pocket costs for medicines. Policymakers should closely monitor changes in overall affordability, including all patient out-of-pocket expenditures, for medications in the program. Preemptive measures should be considered to ensure that the most vulnerable citizens are not placed in precarious situations, leading to poorer health outcomes.<\/jats:p> <\/jats:sec>","DOI":"10.36469\/001c.125251","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T18:51:59Z","timestamp":1732733519000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":0,"title":["Could the Inflation Reduction Act Maximum Fair Price Hurt Patients?"],"prefix":"10.36469","volume":"11","author":[{"given":"Anne M.","family":"Sydor","sequence":"first","affiliation":[{"name":"Global Healthy Living Foundation, Upper Nyack, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esteban","family":"Rivera","sequence":"additional","affiliation":[{"name":"Global Healthy Living Foundation, Upper Nyack, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Popovian","sequence":"additional","affiliation":[{"name":"Global Healthy Living Foundation, Upper Nyack, New York, USA"},{"name":"Pioneer Institute, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"22273","published-online":{"date-parts":[[2024,11,27]]},"reference":[{"key":"ref1","article-title":"IRA\u2019s impact on the U.S. biopharma ecosystem","author":"D. 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