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From Health Affairs:

New ACA Coverage Enrollees Increased Prescription Use And Lowered Spending

Bethesda, MD—While there is evidence that the Affordable Care Act’s (ACA’s) coverage expansion provisions have increased the number of Americans covered by health insurance, less information exists about how new enrollees, particularly those with chronic health conditions, have used it. A
new study, released as a Web First by Health Affairs, compared prescription fills and out-of-pocket spending for a panel of 6.7 million prescription drug users (including those paying entirely out of pocket for prescriptions), before and after the ACA’s implementation. The newly insured people filled, on average, 28 percent more prescriptions and had 29 percent less out-of-pocket spending per prescription in 2014 compared to 2013. Those gaining Medicaid coverage had larger increases in prescription fill rates (79 percent) and reductions in out-of-pocket spending per prescription (58 percent) than those who gained private insurance (with 28 percent more fills and 29 percent less out-of-pocket spending per fill). The study identified individuals with five chronic condition categories: diabetes, hormone therapy for breast cancer, depression or anxiety, asthma or chronic obstructive pulmonary disease (COPD), and high cholesterol or triglycerides. The study group increased its prescription use at about the same rate as those without chronic health conditions. However, the reductions in out-of-pocket spending were pronounced: For example, patients with high cholesterol paid $359 less in out-of-pocket costs in 2014 compared to 2013 if covered by Medicaid in 2014 and $200 less if holding private insurance in 2014. (See exhibit below.) The study transaction data came from the IMS Health’s Integrated Data Warehouse.

Gaining Coverage Through Medicaid Or Private Insurance Increased Prescription Use And Lowered Out-Of-Pocket Spending

By Andrew W. Mulcahy, Christine Eibner, and Kenneth Finegold

Mulcahy and Eibner are affiliated with the RAND Corporation; Finegold is with the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.

This study will also appear in the September issue of Health Affairs. 

“In addition to coverage changes, we identified important utilization and economic impacts of the coverage expansion on patients,” the authors concluded. “These results demonstrate that decreasing financial barriers to care under the ACA has increased treatment rates while reducing out-of-pocket spending, particularly for people with chronic conditions.”

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with frequent Web First studies and health policy briefs published at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, it then switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the iPad app.