(128) Evaluating the Role of Drug Pricing Tiers in Shaping Healthcare Outcomes for Elderly Patients

Background: : This research examines the impact of formulary drug tier systems on medication availability and cost for senior citizens in the New York metropolitan region. The examination of Medicare formularies and frequently prescribed drugs for geriatric issues, it underscores disparities in tier positioning and expenses that could
negatively impact patient outcomes. Concentrating on Alzheimer’s dementia, COPD, Rheumatoid Arthritis, Ischemic Heart Disease, and T2DM, the results highlight the necessity for fair healthcare policies to tackle financial and medical difficulties, guaranteeing equitable access to vital medications.

Objective: : This research examines the impact of Medicare formulary tier positioning on medication affordability, accessibility, and treatment compliance for elderly individuals in NYC, highlighting chronic conditions and promoting fair policy changes.

Methods: : This study examined Medicare formulary tier systems, the primary insurance model for elderly residents in New York City, focusing on medications for Alzheimer’s disease, COPD, rheumatoid arthritis, ischemic heart disease, and diabetes. Tier placement data from Medicare Part D formularies were analyzed, along with the criteria for assignment. The three most commonly prescribed drugs for each condition were identified using
healthcare data and literature. An economic analysis assessed the costs of these medications, highlighting their financial impact on patients.

Results: : The research highlighted chronic illnesses among NYC's elderly, revealing inequalities in Medicare Formulary Tier medication affordability. Alzheimer’s treatments like galantamine and rivastigmine were often in higher tiers, raising out-of-pocket costs. COPD medications, including Symbicort and Trelegy Ellipta, despite preferred
tier placement, posed financial challenges. Rheumatoid arthritis drugs, particularly Humira in Tier 5, imposed heavy costs. Similarly, ischemic heart disease and type 2 diabetes medications like Eliquis and Steglatro often appeared in higher tiers, worsening adherence issues

Conclusions: : Older patients in the U.S. face significant financial challenges from rising prescription costs, despite relief efforts like the Inflation Reduction Act. These pressures lead to poor adherence and negative health outcomes. The findings call for stronger policies to improve price transparency, ensure affordable generics, and prevent unjust placement of generics in higher tiers, particularly for dual-eligible Medicare and Medicaid patients.

Sponsorship:: None