Following the passage of the Inflation Reduction Act in 2022, healthcare systems in the United States are facing many changes in the name of saving costs and creating efficiencies. But do the benefits actually outweigh the costs? 

GCOA’s issue brief, “Utilization Management Post-Inflation Reduction Act and the Threat to Healthy Aging,” addresses the unintended negative consequences of utilization management (UM) on older, minority and other underserved populations. As the population aged 65 and older grows rapidly, projected Medicare costs are soaring, prompting insurers to adopt UM strategies to control expenses. These methods—such as step therapy, prior authorization, and quantity limits—aim to assess the necessity of medications but often restrict patient access and delay essential treatments.  

UM disproportionately affects older Americans, many of whom manage multiple chronic conditions and rely on numerous medications. Additionally, underserved populations face higher claim rejections, exacerbating existing health disparities. Delays in accessing critical treatments can lead to severe health consequences, particularly for those who rely on uninterrupted access to the best medications for their treatment plan. 

Administrative burdens imposed by UM further complicate care, increasing stress for patients, caregivers, and healthcare providers – all begging the question whether UM strategies truly result in any net savings. The brief calls for a reevaluation of UM as a cost-saving method, advocating for alternative solutions that prioritize patient health and equitable access to medications, particularly as our aging population continues to grow. 

This issue brief was made possible by support from Bristol Myers Squibb.