Characteristics, Medication Use of Early Marketplace Enrollees

Individuals who enrolled in health insurance on the Affordable Care Act (ACA)’s marketplaces had lower average drug spending and were less likely to use most medication classes than patients with employer-sponsored coverage, according to a study published in Health Affairs.

The researchers used data on more than 1 million marketplace enrollees from Express Scripts and compared the characteristics and medication use between early and late marketplace enrollees and between all marketplace enrollees and those with employer-sponsored insurance.

Approximately a third of enrollees studied were considered early enrollees and 67.5% were considered later enrollees. The authors found that early enrollees tended to be older and live in areas with higher education and median family income. They were also more likely than later enrollees to have prior coverage through Express Scripts (43.5% compared to 27.6%).

“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,” lead author Julie M. Donohue, PhD, associate professor and vice chair for research in the University of Pittsburgh’s Department of Health Policy and Management, said in a statement.

According to the data from Express Scripts, marketplace enrollees were less likely than those with employer-sponsored coverage to have any drug usage during the study period (55% vs 63.5%), although early enrollees were significantly more likely than later enrollees to have drug usage (66.5% vs 50%).

Marketplace enrollees overall filled fewer prescriptions than the comparison group, and a greater proportion of their prescriptions were for generic drugs. As a result, Marketplace enrollees spent $73 on drugs compared with $93 by those with employer-sponsored coverage.

However, while Marketplace enrollees were less likely to use traditional medication classes, they had a significantly higher use of drugs to treat hepatitis C and HIV.

“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.”