As the U.S. Supreme Court considers the legality of tax subsidies to buy health insurance under the Affordable Care Act (ACA), an investigation by the University of Pittsburgh Graduate School of Public Health, the RAND Corporation and Express Scripts provides an unprecedented look at prescription data gleaned from over a million initial enrollees.

[Photo:Dr. Julie M. Donohue]

The analysis is published online as a Web First article by Health Affairs and in the journal’s June issue.

The study found that among people who enrolled in individual marketplaces, those who enrolled earlier were older and used more medication than later enrollees. Marketplace enrollees, as a whole, had lower average drug spending per person and were less likely to use most medication classes than patients enrolled in employer-sponsored health insurance. However, marketplace enrollees were much more likely to use medicines for hepatitis C and for HIV.

“Not since the 1960s has the United States seen an expansion of insurance coverage like that produced by the ACA, with millions of Americans enrolling in the first year,” said lead author Dr. Julie M. Donohue, associate professor and vice chair for research in Pitt Public Health’s Department of Health Policy and Management. “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.”

Dr. Donohue and her team looked at data on medication use from January through September 2014 on 1 million ACA-established marketplace insurance plan enrollees. The data came from Express Scripts – the largest pharmacy benefits manager in the nation – which kept individual information on enrollees confidential to protect their privacy.

“Our partnership with Express Scripts enabled an early look at the prescription use of around one in every seven marketplace enrollees, which is a unique vantage point to examine the ACA. Our findings on specialty medication use in marketplace plans are particularly important, given the general concerns about the rising costs of these medications for consumers,” said senior author Dr. Walid F. Gellad, adjunct scientist at RAND and associate professor at Pitt and the Pittsburgh VA Medical Center.

This work was funded through a contract from Express Scripts to RAND.

For more information visit http://www.upmc.com/media/NewsReleases/2015/Pages/donahue.aspx.