Thousands Died After Losing Medicare Drug Help. Here’s What Went Wrong

New research reveals alarming connections between Medicare prescription drug coverage disruptions and mortality rates among America’s most vulnerable seniors. Low-income older adults who lost access to the Medicare Part D Low-Income Subsidy (LIS) experienced mortality increases between 4 and 22 percent, according to a University of Pennsylvania study published in the New England Journal of Medicine. Meanwhile, a separate Mass General Brigham study found that nearly 3 million Medicare beneficiaries lost their Part D insurer between 2024 and 2025 – a dramatic surge compared to previous years.

These twin developments paint a concerning picture for Medicare recipients dependent on prescription medications. As policy changes reshape the Medicare landscape, what happens when cost-saving measures for some lead to life-threatening gaps for others?

Medication Access Directly Impacts Survival Rates

The Penn Medicine and Harvard study examined nearly one million low-income Medicare beneficiaries who lost Medicaid coverage – and with it, the Low-Income Subsidy worth approximately $6,200 annually that helps afford medications.

“When Medicare beneficiaries lose Medicaid, which happens to more than 900,000 people each year, they also risk losing the LIS and therefore, being able to afford the medicines they need,” said lead author Eric T. Roberts, associate professor of General Internal Medicine at the University of Pennsylvania Perelman School of Medicine.

The research team identified concerning mortality patterns. People who lost the subsidy earlier saw a 4 percent higher mortality rate than those who retained it longer. The consequences were dramatically worse for certain groups:

• Mortality increased 22 percent among individuals using HIV antiretroviral therapy
• Over 2,900 people died during the study period
• More than half of those who lost Medicaid regained it within a year, suggesting many were incorrectly dropped despite remaining eligible

José F. Figueroa, senior author and associate professor at Harvard Chan School, emphasized the life-saving importance of coverage continuity: “These findings show that helping low-income Medicare beneficiaries who are eligible for Medicaid stay enrolled and retain the LIS can save lives since it preserves access to essential medications.”

Inflation Reduction Act Creates Market Disruptions

As the Low-Income Subsidy program faces challenges, broader disruptions are emerging across Medicare Part D. New JAMA research shows 7.5 percent of beneficiaries – representing 2.9 million people – lost their Part D insurer between 2024 and 2025. This marks a dramatic increase from previous years, when only 0.1 to 2.3 percent experienced insurer exits.

The surge coincides with implementation of the Inflation Reduction Act (IRA), which made significant changes to Medicare Part D prescription drug benefits. While the reforms improved affordability through measures like a $2,000 annual out-of-pocket spending cap, they also increased financial risks for insurers.

Standalone Part D plans were particularly affected, with 10.8 percent of enrollees losing coverage compared to 4.5 percent in Medicare Advantage prescription drug plans. Enhanced plans saw higher disruption rates (8.9 percent) than standard plans (1.3 percent).

Coverage Gaps Lead to Treatment Disruptions

The consequences of these market shifts extend beyond administrative hassles. When patients must switch plans, differences in formularies – the lists of covered medications – can disrupt treatment regimens and potentially reduce medication adherence.

“These insurer exits will contribute to decreased competition, which may lead to decreased patient choice and eventually higher out-of-pocket costs,” said lead author Christopher L. Cai of Mass General Brigham’s Program On Regulation Therapeutics, and Law.

For vulnerable populations with complex medical needs, such disruptions can have serious impacts. The research from Penn Medicine showed that those with more expensive medications and greater clinical needs faced the highest mortality risks when losing coverage.

Potential Solutions on the Horizon

Researchers suggest several policy approaches to address these emerging challenges. “Congress may need to take steps to stabilize the situation. This could include lowering the legal ceiling on annual deductibles, which is currently $590, or introducing a public Part D standalone option to promote competition,” Cai noted.

The Penn Medicine team emphasized the importance of continuity in existing programs. “As policymakers consider major changes to the Medicaid program, preserving Medicaid coverage for older adults is critical to ensuring that they keep the LIS,” Roberts added.

With Medicare Part D covering over 38 million Americans, the stakes are high. As implementation of the Inflation Reduction Act continues through 2025 and beyond, health policy experts will be watching closely to see if the benefits of reduced out-of-pocket costs outweigh the market disruptions currently affecting millions of older Americans.