People newly covered by Medicaid drove a significant increase in prescription drug use in 2014, even as those with private commercial coverage filled fewer prescriptions and, over all, patients did not visit the doctor as often, according to a new report by the IMS Institute for Healthcare Informatics, which tracks the health industry.
The report, released on Tuesday, offers a window into how consumers used their insurance in 2014, the first full year after millions of Americans gained coverage through the health care law, which expanded eligibility for Medicaid in many states and set up marketplaces where consumers could shop for insurance.
Patients with Medicaid in states that expanded access to the program filled 25.4 percent more prescriptions than in the previous year, before the expansion. In states that opted not to expand the program, the increase was much smaller at 2.8 percent.
Sabrina Corlette, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University, described the difference as "stark," adding, "it suggests that in the Medicaid expansion states, people are accessing the health care system. They are seeing physicians and other prescribers and getting needed drugs."
The report also provided some new details on the overall growth of spending on prescription drugs, which, it said, rose substantially in 2014 — by 13.1 percent, to $373.9 billion. The increase is the highest since 2001 — mainly because of the arrival of expensive new drugs for conditions like hepatitis C, cancer and multiple sclerosis, at the same time that sales eroded less for brand-name drugs because of new competition with generic drugs. Spending on so-called specialty drugs — high-priced treatments that typically treat serious chronic diseases — accounted for one-third of drug spending in 2014, up from 23 percent five years ago.
Last year "was a remarkable year in terms of growth in spending on medicines," said Murray Aitken, executive director of the IMS Institute. But he added that while growth in specialty drug spending was expected to continue, the eye-popping increase in 2014 was unique and spending would most likely not rise as sharply in future years.
The report sheds some light on who enrolled in coverage through the new marketplaces. The IMS Institute found that 70 percent of people who used a marketplace plan to fill a prescription in 2014 had been covered by commercial insurance in 2013, either through an employer or through purchasing an individual plan. Nearly a quarter — 24 percent — paid cash in 2013, meaning they may have been uninsured. In all, the number of prescriptions paid in 2014 with cash declined by 5.5 percent compared to 2013.
Steven Jacobsohn, a retired financial analyst who lives in Manhattan, said his prescription drug coverage improved in 2014, when he switched from individual coverage through EmblemHealth to a less expensive marketplace plan sold by Health Republic. He said two common generic drugs to treat high cholesterol and blood pressure cost $10 a month under his old policy, but were free under the Health Republic plan. "It's a very good plan," said Mr. Jacobsohn, who is 57.
But even as some have seen their options improve, the report found that many are cutting back on prescription drug use and doctor visits. Many marketplace plans — and, increasingly, plans through employers — come with high deductibles and co-payments, forcing some patients to make tough choices.
Over all, patients made 3 percent fewer office visits and had 1.7 percent fewer hospital admissions. They filled slightly more prescriptions — 2.1 percent — but that was mainly driven by the large increases among Medicaid patients, the report found.
Researchers found that patients who took one type of diabetes drug were less likely to take the drug after their own costs reached $30, and even more so when their costs exceeded $125. Patients who had recently changed to a plan with a deductible took their drug for 25 fewer days, on average, compared to those with more comprehensive plans.
Gary Claxton, a vice president at the Kaiser Family Foundation, said it was difficult to generalize about consumers' coverage under high-deductible plans because they can vary widely in how they are set up. Still, he said, previous studies support the idea that "with more cost-sharing, you get less use."
Mr. Jacobsohn counts himself among patients who have let costs drive his health care decisions. Last year, he said, his doctor suggested that he switch from his generic atorvastatin prescription to Crestor, a more expensive brand-name drug, because his cholesterol was too high. When he learned that the Crestor prescription came with a $60 co-payment, Mr. Jacobsohn said he decided to wait six months to give the cheaper drug another chance to work. His cholesterol improved at the next visit and he never switched to Crestor.
"Not that I couldn't afford it," Mr. Jacobsohn said. "I just didn't know if I wanted to pay for it."
