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Medicaid expansion under Affordable Care Act increased prescription filing

The number of prescriptions filled by adults using Medicaid increased by nearly 20% in the first 18 months of the Affordable Care Act’s implementation, according to findings recently presented at the Society of General Internal Medicine Meeting.

“In recent years, the high prices of life-saving hepatitis C and HIV medications have fueled debate about the role of public policy in providing access to costly but effective pharmacological treatments for vulnerable populations. Moreover, care management through prescription drugs may potentially reduce the use of more resource-intensive medical care such as [ED] visits or other non-drug spending,” Ausmita Ghosh, department of economics, Indiana University Purdue University-Indianapolis, and the National Bureau of Economic Research, and colleagues wrote. “Utilization of prescription medications can also provide early evidence of [the Affordable Care Act’s] Medicaid expansion effects on access to providers, because prescriptions can only be obtained through consultation with a medical practitioner with prescriptive authority.”

Researchers used a difference-in-difference approach to compare the number of prescriptions filled in expansion states vs. non-expansion ones before the Affordable Care Act (ACA) took effect and 15 months after it was implemented, and what type of insurance was used to fill each prescription.

Ghosh and colleagues found that overall, the number of prescriptions filled by adults increased by19%. Drugs used for treating diabetes accounted for the largest growth among all drug classes, with an increase of 24%, followed by contraceptives (22%), CV drugs (21%), and mental health drugs (19%). Prescriptions for drugs more consistent with allergies and infections had increases ranging from 16 to 17%. In addition, within expansion states, researchers found increases in prescription drug utilization were larger in geographical areas with higher uninsured rates prior to the ACA, and there was “suggestive evidence” that increases in prescription drug utilization were greater in areas with larger Hispanic and black populations.

“The estimates from this study, using recently available data, are applicable to the ongoing health policy debates surrounding the effects of the ACA; they are especially relevant, moreover, for understanding the implications of the Medicaid coverage expansions for health care use on the part of low-income Americans,” Ghosh and colleagues wrote.

“Our findings suggest a significant and positive impact of the ACA Medicaid expansions on the use of prescription drugs in expansion states, which is consistent with the impact of insurance coverage expansions on improving access to care.”

This research is consistent with studies in the New England Journal of Medicine and the Annals of Family Medicine that have refuted claims, made mostly by Republicans, that the Affordable Care Act restricted access to health care. – by Janel Miller

Disclosure: Healio Family Medicine was unable to determine the researchers’ relevant financial disclosures prior to publication.