The number of Medicaid prescriptions has surged as a result of expanded eligibility brought by the Affordable Care Act, according to Symphony Health Solutions.


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Study: ACA fuels rise in Medicaid prescriptions

April 2nd, 2014

HORSHAM, Pa. – The number of Medicaid prescriptions has surged as a result of expanded eligibility brought by the Affordable Care Act, according to Symphony Health Solutions.

The health care analytics and technology firm said Wednesday that its research on the ACA's early impact on demand for pharmaceuticals showed that prescription claims for Medicaid patients rose 10% in January and 14% in February year over year.

"Even with Medicaid expansion less than three months old, we're starting to see notable increases in Medicaid prescription claims," Don Otterbein, senior vice president of marketing and product management at Symphony Health Solutions, said in a statement. "We expect this trend to continue and, mostly likely, to increase as newly enrolled Medicaid patients seek healthcare services."

The Centers for Medicare & Medicaid Services (CMS) projects enrollment in Medicaid to rise by 8.7 million people in 2014, noting that nearly all of that growth will come from the ACA coverage expansion. Medicaid spending is estimated to increase 12.2% this year.

Another 8.8 million people are expected to enroll in Medicaid by 2016, as some states are slated to expand their programs after 2014, according to CMS. The agency forecasts Medicaid spending to grow by an average of 7.9% in 2015 and 2016.

Symphony Health's study also revealed that the average out-of-pocket cost for contraceptives has fallen more than 58% since 2012. Out-of-pocket expenses for these drugs began to drop immediately after the implementation of the ACA birth control mandate in August 2012, the company noted. The cost of contraceptives declined from a high of $17.54 in July 2012 to $7.36 in February 2014.

"These reductions in patient costs accelerated when plans launched their annual benefit designs in January 2013," Otterbein stated. "This trend is expected to continue this year, although it is starting to slow."

For its research, Symphony Health examined third-party and state-run Medicaid data using Dynamic Claims Lifecycle, its managed care research product that leverages claims data from more than 42,000 retail pharmacies. For the contraceptive research, Symphony looked at commercial payers, female patients and the drug class for contraceptive agents using PHAST 2.0 Prescription Monthly, which the company said uses the industry's largest sample of retail sales data along with Dynamic Claims Lifecycle.

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