Affordability at risk: Inflation, aging, and the future of prescription drug access after IRA reforms.

269 Background: Access to prescription drugs is a major concern for adults 65 and older, especially those on Medicare with cancer, as high drug costs can cause significant financial strain. Many live on fixed incomes and are vulnerable to the effects of inflation, which further erodes their ability to afford medications. As a result, some may skip doses or ration prescriptions, risking serious health issues and higher healthcare costs. To address these challenges, the Inflation Reduction Act (IRA) of 2022 introduced key reforms to Medicare Part D aimed at improving access and reducing financial burdens. By restructuring financial obligations, the IRA aims to create a fairer system, especially for Medicare beneficiaries burdened by high drug costs. Our aim was to gather baseline data on the impact of drug costs for cancer patients following full implementation of the IRA. Methods: Cross-sectional analysis used data from a nationwide January 2025 survey by Patient Advocate Foundation (PAF). Inclusion criteria included a valid email address, age ≥19, Medicare coverage, no low-income subsidy, and self-reported cancer diagnosis. Frequencies were calculated for categorical variables. Results: A total of 565 cancer patients completed the survey. Respondents were female (61%), age ≥56 (88%), white (69%), household income < $35,000 (58%), and suburban location (44%). Common cancer types included multiple myeloma (47%); breast (18%); prostate (8%). One third (32%) were diagnosed ≤2 years and 97% reported treatment in past 12-months. Primary sources of income included disability payments (30%) or Social Security (56%); 40% reported no secondary income. In the past 12-months, 60% reported rising prescription costs, and 36% faced access issues due to unaffordable copays, coinsurance, or deductibles. Over half (53%) said they would skip, reduce, or stop medications if costs rose further, while 45% indicated they could not afford any additional increase ($0) before compromising prescribed care. Recent behavior changes related to prescription drug costs included delaying (37%), not filling (35%), smaller dose (31%) or skipping (29%). Two-thirds (65%) requested a switch to generic drugs to address rising medication costs. Conclusions: Although IRA changes cap out-of-pocket drug costs at $2,000, changes to true out-of-pocket (TrOOP) calculations shift more cost responsibility to the plan design, reducing guaranteed third-party contributions and potentially increase patient cost-sharing burdens. While the reforms aim to ease expenses for the small percentage of patients on high cost-medications, survey results show many Medicare patients will still face substantial financial hardship.