Impact of the inflation reduction act on Medicare MTM eligibility among beneficiaries with diabetes: evidence from 2022-2023.

BACKGROUND: The Inflation Reduction Act (IRA) introduced an insulin cost cap in 2023 to reduce patient out-of-pocket costs, but these changes may have unintended implications for drug-cost-based eligibility for the Medicare Medication Therapy Management (MTM) program. MTM services, intended to improve pharmacotherapy outcomes, had lower enrollment among racial and ethnic minorities. This study evaluated whether the IRA was associated with differential changes in MTM eligibility across racial and ethnic groups. RESEARCH DESIGN AND METHODS: Data from the 2022-2023 Medical Expenditure Panel Survey were analyzed. Medicare beneficiaries with diabetes were compared with privately insured near-elderly adults using a difference-in-differences framework. Changes in rates of exceeding the drug cost threshold for MTM eligibility were compared by race and ethnicity. RESULTS: The temporal increases in these rates were significantly smaller among Medicare beneficiaries than in the comparison group for non-Hispanic White (White) individuals. Hispanic and non-Hispanic Asian beneficiaries experienced greater increases in these rates than their White counterparts. No significant differential change was observed between non-Hispanic Black and White beneficiaries. CONCLUSIONS: Initial IRA implementation was associated with narrowing Hispanic-White and Asian-White differences in meeting the drug-cost threshold for MTM eligibility. Part D affordability reforms may influence cost-based program eligibility, with equity implications.