Patients with ACA coverage filled more prescriptions, but spent less of their own money per drug

New research suggests that the Affordable Care Act has increased treatment rates while reducing out-of-pocket spending.

The research was published online by Health Affairs Wednesday.

For the study, researchers analyzed prescription transaction data for 6.7 million people who filled prescriptions and compared changes in coverage, prescription fills, plan spending and out-of-pocket spending before and after the implementation of the ACA's coverage expansion. Thirty percent of those people were uninsured in 2013, before the ACA coverage took effect in January 2014.

The study found that uninsured people who gained private coverage filled, on average, 28 percent more prescriptions and had 29 percent less out-of-pocket spending per prescription in 2014 compared to 2013. The study also found people who gained Medicaid coverage had larger increases in fill rates (79 percent) and reductions in out-of-pocket spending per prescription (58 percent).

Researchers noted that the ACA particularly increased treatment rates while reducing out-of-pocket spending for people with chronic conditions such as diabetes, breast cancer, depression, asthma and high cholesterol. The study found people who gained coverage and had at least one of these chronic conditions saw larger decreases in out-of-pocket spending compared to those who did not have at least one condition.

"People who gain coverage filled more prescriptions and spent a lot less out of pocket. It speaks to the potential health benefits from gaining coverage," Andrew Mulcahy, the study's lead author and a health policy researcher at the RAND Corp., a nonprofit think tank based in California, said, according to Kaiser Health News. "It speaks to the barriers to getting care when you don't have insurance."

Still, Jonathan Kolstad, an assistant professor of economic analysis and policy at the University of California, Berkeley, pointed out to Kaiser Health News that the research doesn't have enough evidence in it to determine if newly insured people are being compliant with their medications, or if the drugs are helping them manage their conditions and improve their wellbeing.

The publication also noted that researchers said there was a limitation on their study because the people surveyed were already getting prescriptions, so they could have, for instance, been more likely to seek out a physician than the average consumer.



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