New research highlights continued healthcare access and affordability challenges, need for charitable foundation support among Medicare patients

Today, Patient Advocate Foundation (who announced a strategic merger with PAN Foundation in March 2026) released findings from two sets of national research that point to the continued access and affordability challenges older adults enrolled in Medicare are facing, despite recent reforms included in the Inflation Reduction Act. Both bodies of research explored the real-life impact these reforms had on patients’ ability to access and afford their needed healthcare, highlighting the ongoing need for charitable patient assistance foundation support.

Analysis on impact of key Medicare reforms on patients

To better understand the impact that key reforms included in the Inflation Reduction Act are having on Medicare patients, the PAN Foundation enlisted IQVIA to conduct analysis across five high-cost therapeutic areas. The therapeutic areas included prostate cancer, breast cancer, multiple sclerosis, rheumatoid arthritis, and pulmonary arterial hypertension.

Two key Inflation Reduction Act changes impacting patient cost and implemented in 2025 were examined—the $2,000 annual out-of-pocket cap on Medicare Part D prescription medications and the new Medicare Prescription Payment Plan (MPPP). The analysis found that while patients who have filled a medication before face high out-of-pocket costs at the beginning of the year until they hit the cap, patients attempting to start a new medication occur throughout the year, needing financial support later in the year.

Some other key findings from the analysis include:

Despite some benefits from the reforms, affordability continues to be a barrier for many.

• While the $2,000 annual out-of-pocket cap on Medicare Part D prescription medications reduced the number of patients abandoning high-cost therapies by 23 percent, many patients (40 percent) are still abandoning their therapies, in large part due to cost; the $2,000 annual out-of-pocket cap remains a significant financial barrier to treatment initiation.
• In 2025, the annual out-of-pocket cap likely helped more patients (13 percentage points higher) stay on their high-cost therapies longer throughout the year because they were shielded from costs, when compared to 2023.

Support from charitable foundations remains critical.

• The abandonment rate from patients on high-cost therapies drops from 58 percent among those with no foundation support to only 5 percent among those with foundation support.
• Receiving foundation support eliminates costs barriers and drastically reduces abandonment, highlighting the continued impact of this type of support.

More awareness and education are needed around MPPP.

• Enrollment in MPPP is low (7 percent) among standard Medicare Part D patients on high-cost therapies, with no meaningful differences seen across patient demographics.
• However, in high-cost therapeutic areas, participation in MPPP reduces abandonment by 24 percentage points, pointing to the effectiveness of the program.
• The low adoption but high effectiveness of MPPP presents an opportunity to strengthen awareness and education about the program to increase participation.

Medicare patient survey on financial burden

Separately, Patient Advocate Foundation’s Patient Insight Institute conducted a national cross-sectional survey of Medicare patients who received assistance from Patient Advocate Foundation or the PAN Foundation in 2025 to better understand the financial burdens they face with their care. The sampling included 4,229 English speaking non-Low-Income Subsidy (LIS) Medicare patients, mostly living with chronic or serious conditions—representing one of the largest sample sizes of a survey of this kind.

Of those surveyed, 86 percent report living at or below 400 percent of the federal poverty level (FPL), with 44 percent reporting an annual income of less than $35,000. In addition, 83 percent of those surveyed rely on fixed income as their primary source of household income and 39 percent report having no secondary source of income.

Some key findings from the survey include:

Healthcare costs are rising, forcing patients to make difficult decisions regarding their care.

• In the past 12 months, 33 percent of patients experienced challenges in accessing prescribed care or treatment due to copay, coinsurance, or deductible costs.
• There are several steps patients report often or sometimes taking to afford their care, including:
  • Requesting a generic brand (66 percent)
  • Spending less on non-medical needs (41 percent)
  • Stopping or substituting medication (40 percent)
  • Delaying filling a prescription (31 percent)
  • Not filling a prescription (30 percent)
  • Taking a smaller dose of a prescription (26 percent)
  • Skipping a dose of medication (23 percent)
• Most patients have seen a slight or significant increase in their costs associated with healthcare insurance premiums (71 percent), direct care from providers (59 percent), and prescription medications (58 percent) over the past 12 months.
• If costs were to increase, 53 percent of patients would be somewhat or very likely to skip, reduce, or stop taking medications, with 5 percent reporting they already skip, delay, or reduce care and treatment due to cost.

Annual out-of-pocket cap helps patients, while MPPP awareness remains low.

• While 59 percent of patients report paying more for out-of-pocket prescriptions in 2025 compared to 2024, 57 percent reported that the Part D cap allowed them to afford other healthcare costs and 52 percent reported it allowed them to afford other nonmedical costs.
• 60 percent of patients reported hitting the $2,000 out-of-pocket cap between January and March, with 40 percent hitting the cap later in the year.
• Although 56 percent of patients reported hearing about the MPPP, only 6 percent reported participating in the program.

“While the reforms included in the Inflation Reduction Act have helped some patients, our analysis and patient survey make it clear that safety net organizations, like Patient Advocate Foundation, continue to have a critical role to play in connecting patients with the support they need,” said Alan J. Balch, PhD, CEO of Patient Advocate Foundation and incoming Executive Chairman of the Board of Directors. “That’s why we remain committed to serving a single, trusted destination for people seeking support, regardless of insurance status, age, income, or diagnosis.”

“Both bodies of research point to the ongoing challenges and barriers Medicare patients face when it comes to accessing and affording their healthcare, highlighting the continued need for to advocate for healthcare reforms and systems change that expand access to care for everyone,” said Amy Niles, Chief Mission Delivery Officer of Patient Advocate Foundation.

About Patient Advocate Foundation

Patient Advocate Foundation is the nation’s most comprehensive nonprofit dedicated to helping patients navigate, access, and afford their care while improving the healthcare system for all. We provide financial assistance to help patients afford treatment and cost of living needs, personalized case management to navigate complex healthcare and social needs challenges, and a wide array of resources to empower people to take charge of their health.

Since our founding in 1996—and joining forces with the PAN Foundation in 2026—we have helped more than 3.8 million people access and navigate care, granted over $7 billion in financial assistance, provided personalized case management support to over 350,000 patients, and elevated the patient’s voice to drive improvements in the healthcare system.

Learn more at Uniting.PatientAdvocate.org.