ACA Coverage Leads to More Prescriptions, Less Out-of-Pocket Costs

People who gained insurance coverage following the Patient Protection and Affordable Care Act (ACA) coverage expansion filled more prescriptions and paid significantly less out-of-pocket compared with those who lacked health coverage, according to a study in Health Affairs.

“This is strong evidence that the ACA has increased treatment rates while reducing out-of-pocket spending, particularly for people with chronic health conditions,” said study lead author Andrew W Mulcahy, PhD, a health policy researcher at the nonprofit RAND Corp. “Improving the treatment of people with chronic conditions is an important step in improving health outcomes.”

The study looked at prescription transactions over a 3-year period for nearly 6.7 million people who originally used a retail pharmacy in January 2012, before the coverage expansion. Between 2013 and 2014, the number of people in the study population—which was adjusted to represent prescription drug users nationally—who lacked health coverage dropped 30%, the researchers reported.

Among those who gained private insurance through the online marketplaces, prescriptions increased an average 28% while out-of-pocket spending per prescription dropped 29% compared with the previous year when they did not have insurance, according to the study. People who gained Medicaid coverage filled 79% more prescriptions and spent 58% less out-of-pocket than they did before coverage.

Individuals with one or more chronic conditions such as diabetes and asthma, who gained coverage saw larger decreases in out-of-pocket spending than new enrollees without chronic conditions.

The study also found that states that expanded Medicaid by early 2014 had much larger drops in the rate of residents without insurance (39%) than states that did not expand Medicaid (23%).—Jolynn Tumolo