Publications

2026

Marinacci, Lucas X, Stephen Mein, Benjamin N Rome, and Rishi K Wadhera. (2026) 2026. “Cost-Related Medication Nonadherence After the Inflation Reduction Act.”. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2026.0012.
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IMPORTANCE: High prescription drug costs are a pressing national concern and contribute to medication nonadherence and poor health outcomes. The Inflation Reduction Act (IRA) introduced sweeping reforms to improve medication affordability, but their potential impact on medication adherence is unknown.

OBJECTIVE: To evaluate the association of the IRA's 2024 prescription drug provisions with cost-related medication nonadherence as well as health care-related financial strain.

DESIGN, SETTING, AND PARTICIPANTS: This quasi-experimental difference-in-differences analysis used data from the 2021-2024 National Health Interview Survey. Adults aged 62 to 67 years who were enrolled in Medicare Part D (intervention) or private insurance (comparator) were included. Individuals with incomes 135% or less of the federal poverty level, dually enrolled in Medicaid, and who currently used insulin were excluded from the primary analysis because preexisting protections limited their out-of-pocket spending in Medicare.

EXPOSURES: The IRA's prescription drug provisions were enacted on January 1, 2024, including (1) elimination of the 5% coinsurance requirement for catastrophic coverage that effectively capped out-of-pocket drug costs to approximately $3300 per year and (2) expansion of full low-income subsidies.

MAIN OUTCOMES AND MEASURES: The primary outcome was cost-related medication nonadherence. The secondary outcome was health care-related financial strain.

RESULTS: The study population included 1454 Medicare beneficiaries (weighted mean [SD] age, 66.1 [0.8] years; 53.1% female) and 3797 privately insured comparators (weighted mean [SD] age, 63.3 [1.2] years; 50.7% female). Prior to the 2024 IRA reforms, trends in cost-related medication nonadherence were parallel between the 2 groups. Following implementation of the IRA's 2024 provisions, cost-related medication nonadherence declined among Medicare beneficiaries relative to comparators (adjusted difference-in-differences estimate, -4.9 percentage points [pp]; 95% CI, -8.8 to -1.0 pp). Among Medicare beneficiaries with multiple chronic conditions, the decline was more pronounced (adjusted difference-in-differences estimate, -7.8 pp; 95% CI, -12.9 to -2.8 pp). These findings were robust across multiple sensitivity analyses as well as secondary analyses using Medicare beneficiaries with incomes 135% or less of the federal poverty level and dually enrolled in Medicaid as an alternative comparator group. In contrast, there were no meaningful differential changes observed for health care-related financial strain (adjusted difference-in-differences estimate, -2.6 pp; 95% CI, -10.1 to 5.0 pp).

CONCLUSIONS AND RELEVANCE: In this difference-in-differences analysis, the IRA's 2024 prescription drug provisions were associated with a reduction in cost-related medication nonadherence among eligible Medicare beneficiaries in their first year. These early improvements may have important implications for chronic disease management and downstream clinical outcomes.

Harris, Samantha, R J Waken, Fengxian Wang, Khavya C Avula, Rishi K Wadhera, Jose F Figueroa, John Orav, Uchenna Ofoma, and Karen E Joynt Maddox. (2026) 2026. “Factors Associated With Telemedicine Use by Cardiologists for Medicare Beneficiaries in 2022 to 2023: An Observational Study.”. Journal of the American Heart Association 15 (6): e046273. https://doi.org/10.1161/JAHA.125.046273.
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BACKGROUND: During the COVID-19 pandemic, the Centers for Medicare and Medicaid Services created a waiver to reimburse telemedicine services. It is important to understand factors that facilitate incorporation of telemedicine into ongoing cardiovascular practice.

METHODS: This was a retrospective cohort study of telemedicine and office visits delivered by cardiologists between January 1, 2022, and December 31, 2023, for Medicare beneficiaries. We calculated the adjusted incidence rate ratio (aIRR) of telemedicine visits, representing the proportion of a physician's visits delivered by telemedicine, to identify factors associated with telemedicine use.

RESULTS: There were 23 334 physicians in our cohort; they were predominantly men (84.8%) and affiliated with a hospital (93.5%), and the majority were general cardiologists (66.1%). During 2022 and 2023, 3.4% of visits were delivered by telemedicine. In a regression model adjusted for beneficiary and provider characteristics, several physician-level factors were associated with increased telemedicine: female sex (aIRR, 1.48 [95% CI, 1.41-1.57]), electrophysiology specialty (aIRR, 1.57 [95% CI, 1.47-1.67] compared with general cardiology), and caring for a high proportion of beneficiaries living in areas of social vulnerability (quartile 3 aIRR, 1.22 [95% CI, 1.12-1.32]; quartile 4 aIRR, 1.27 [95% CI, 1.16-1.39]). Caring for more beneficiaries residing in a rural area (aIRR, 0.71 [95% CI, 0.66-0.76]) or the South (aIRR, 0.61 [95% CI, 0.55-0.66]) and for beneficiaries aged >85 years (aIRR, 0.77 [95% CI, 0.73-0.81] were associated with lower use of telemedicine).

CONCLUSIONS: Telemedicine is used relatively sparsely among cardiologists. Physician factors, including sex; specialty; and the vulnerability, rurality, and age of beneficiary panels, impact the degree to which telemedicine is a major part of clinical practice.

Vyas, Darshali A, Stephen A Mein, Archana P Tale, and Rishi K Wadhera. (2026) 2026. “Functional Status of Adults at Risk of Medicaid Disenrollment Under National Work Requirements.”. Annals of Internal Medicine. https://doi.org/10.7326/ANNALS-25-04811.
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BACKGROUND: The One Big Beautiful Bill Act (H.R.1) implemented Medicaid work requirements for beneficiaries in states participating in the Affordable Care Act, but congressional policymakers are considering extending work requirements nationally to all Medicaid enrollees. However, little is known about Medicaid-enrolled adults at risk of disenrollment.

OBJECTIVE: To assess the functional status and overall health of adults at risk of Medicaid disenrollment under national work requirements.

DESIGN: Cross-sectional study.

SETTING: Medical Expenditure Panel Survey, 2022-2023.

PARTICIPANTS: Adults aged 19 to 64 years enrolled in Medicaid who did not meet common H.R.1 exemption criteria. Beneficiaries were classified as at risk of disenrollment if they worked less than 20 hours per week.

MEASUREMENTS: Measures of functional impairment across physical, neuropsychological, and independent living domains and composite measures of physical and mental health.

RESULTS: The annual weighted population of Medicaid beneficiaries aged 19 to 64 years was 16.5 million (mean age, 40.5 years; 54.4% female). Among these enrollees, 50.4% or 8.3 million (SE ±0.5 million) would be at risk of disenrollment by working too few hours. Compared with beneficiaries meeting work requirements, those at risk of disenrollment reported higher levels of functional impairment across physical, neuropsychological, and independent living domains. Proportions with poor self-reported health were also higher among beneficiaries at risk of disenrollment than those reporting better health (poor physical health: 32.7% vs. 10.9% and poor mental health: 28.2% vs. 19.5%, respectively).

LIMITATION: Self-reported measures and inability to capture all exemption criteria.

CONCLUSION: Under national Medicaid work requirements considered by Congress, half of all beneficiaries would be at risk of disenrollment even though they had greater functional impairment and poorer health than those who were not at risk. These impairments might not meet formal disability criteria but could compromise enrollees' ability to adhere to work requirements, thereby increasing their risk of coverage loss.

PRIMARY FUNDING SOURCE: Patrick and Catherine Weldon Donaghue Medical Research Foundation.