Health Affairs Web First: New ACA Coverage Enrollees Increased Prescription Use And Lowered Spending

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

"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."

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.

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