Affordable Care Act Enrollees Have Lower Average Drug Spending

Marketplace users less likely to use most medication classes except for hepatitis C and HIV.

While the debate over the Affordable Care Act rages in the US Supreme Court, prescription data from those who gained health care through the legislation has emerged in a study by the University of Pittsburgh Graduate School of Public Health, the RAND Corporation, and Express Scripts.

Published online in Health Affairs the study showed that people who enrolled early on in individual marketplaces were older and used more medication than those who enrolled later on. Overall, marketplace enrollees had lower average drug spending per person and were less likely to use most medication classes than were patients who enrolled through employer-sponsored health insurance.

In contrast, however, marketplace enrollees were found to be much more likely to use drugs that treat hepatitis C and HIV.

"Not since the 1960s has the United States seen an expansion of insurance coverage like that produced by the ACA, with millions of Americans enrolling in the first year," lead author Julie M. Donohue, PhD, said in a press release. "The insights gained by our analysis have implications for the marketing of ACA insurance plans, benefit design and out-of-pocket costs, as well as public health ramifications, such as expanding treatment for infectious diseases like HIV and hepatitis C."

The researchers analyzed medication use data from January 2014 to September 2014 on 1 million ACA marketplace insurance plan enrollees.

“Our findings on specialty medication use in marketplace plans are particularly important, given the general concerns about the rising costs of these medications for consumers," senior author Walid F. Gellad, MD, MPH, said in a press release.

The results showed that marketplace plan enrollees tended to reside in areas where median family income was 9% lower than people in employer-sponsored plans. Marketplace enrollees overall were found to have filled fewer prescriptions and spent less on average per person compared with people on employer-based coverage.

This finding indicates the marketplaces attracted both healthy and sick enrollees during the first year. Early marketplace enrollees were found to have comparable medication use as did those in employer-sponsored plans, but had greater out-of-pocket costs, specifically in terms of specialty drugs.

The study also found the ACA marketplace did not lead to increased insurance premiums due to successfully attracting younger and healthier enrollees, which offset greater costs from older and less healthy enrollees.

"From a public health perspective, our analysis indicates that the ACA is successfully helping more vulnerable populations with lower incomes gain access to medications needed to treat chronic and acute conditions," Dr. Donohue said. "Given the unprecedented expansion of insurance coverage with the ACA, close monitoring of its impact must continue."