(Press-News.org) PITTSBURGH, May 27, 2015 - 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.
The analysis is published online as a Web First article by Health Affairs and will also appear 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 Julie M. Donohue, Ph.D., 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 Walid F. Gellad, M.D., M.P.H., adjunct scientist at RAND and associate professor at Pitt and the Pittsburgh VA Medical Center.
The team compared people who enrolled in marketplace plans "early" (October 2013 through February 2014) and "late" (March through May 2014). They also compared all ACA marketplace enrollees to a matched group of Express Scripts enrollees with employer-based health insurance.
Among the findings:
People who enrolled in marketplace plans early were four years older on average than those who enrolled near the enrollment deadline and filled twice as many prescriptions in the first month of enrollment.
Marketplace enrollees lived in areas where median family income was 9 percent lower than those in employer-sponsored plans.
ACA marketplace enrollees, as a whole, filled fewer prescriptions and spent less on average per person than those with employer-based coverage, suggesting that the marketplaces effectively pooled risk - attracting both healthy and sick enrollees - in their first year.
Early marketplace enrollees had comparable medication use to people in employer-sponsored plans but had higher out-of-pocket costs, particularly for specialty drugs.
Marketplace enrollees had higher use of hepatitis C medications and markedly higher use of HIV medications than those with employer-based coverage.
"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," said Dr. Donohue. "Given the unprecedented expansion of insurance coverage with the ACA, close monitoring of its impact must continue."
The analysis also shows that the ACA marketplaces staved off early concerns about skyrocketing insurance premiums by successfully attracting younger, healthier enrollees to offset higher costs from older, less healthy people, Dr. Donohue added.
INFORMATION:
Additional authors are Eros Papademetriou, M.A., of the Eliassen Group; Sharon G. Frazee, Ph.D., M.P.H., of the Pharmacy Benefits Management Institute; Rochelle R. Henderson, Ph.D., of Express Scripts; Christine Eibner, Ph.D., and Andrew Mulcahy, Ph.D., both of RAND; Ateev Mehrotra, M.D., M.P.H., of RAND and the Harvard Medical School; Can Cui, M.A., of the University of Texas at Austin; Bradley D. Stein, M.D., Ph.D., of RAND and Pitt; and Shivum Bharill, of the University of Michigan.
This work was funded through a contract from Express Scripts to RAND.
About the University of Pittsburgh Graduate School of Public Health
The University of Pittsburgh Graduate School of Public Health, founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health problems. For more information about Pitt Public Health, visit the school's Web site at http://www.publichealth.pitt.edu.
http://www.upmc.com/media
Contact: Allison Hydzik
Phone: 412-647-9975
E-mail: HydzikAM@upmc.edu
Contact: Wendy Zellner
Phone: 412-586-9777
E-mail: ZellnerWL@upmc.edu
It's both the bane of many parents and what has been called a major national vulnerability: the inability of many children to understand mathematics. Understanding that problem and developing strategies to overcome it is the research focus of Nicole McNeil, Alliance for Catholic Education (ACE) Associate Professor of Psychology at the University of Notre Dame, and the researchers in her lab.
A new paper by McNeil and Emily Fyfe, a former Notre Dame undergraduate who's now a doctoral student at Vanderbilt University, examines if the labels educators use to identify patterns ...
KNOXVILLE--Not every encounter between predator and prey results in death. A new study co-authored by a University of Tennessee, Knoxville, professor suggests that prey emit warning cues that can ultimately lead to both their survival and that of their predators.
The hypothesis addresses a 150-year-old mystery of evolution on how warning signals of animals and plants arise and explains animals' instinctive avoidances of dangerous prey.
The study is published this month in the Biological Journal of the Linnean Society. It is available online at http://tinyurl.com/njdq5og.
"People ...
CORVALLIS, Ore. - Teenage girls like and feel more similar to women in appearance-focused jobs such as models and actresses, though they find female CEOs and military pilots to be better role models, according to a new study by researchers at Oregon State University.
For the study, 100 girls and 76 boys ages 14 to 18 were shown photographs of model Heidi Klum, actress Jennifer Aniston, CEO Carly Fiorina and military pilot Sarah Deal Burrow. Klum and Aniston represented the appearance-focused careers and Fiorina and Deal Burrow represented the non-appearance focused careers.
Girls ...
Philadelphia - While advances in technology have made multigene testing, or "panel testing," for genetic mutations that increase the risk of breast or other cancers an option, authors of a review published today in the New England Journal of Medicine say larger studies are needed in order to provide reliable risk estimates for counseling these patients. The international consortium of authors, including researchers at the Basser Center for BRCA at the University of Pennsylvania's Abramson Cancer Center, acknowledges that panel testing can make a useful contribution to predicting ...
Boulder, Colo., USA - Salt rock behaves as a fluid and can play a pivotal role in the large-scale, long-term collapse of the world's continental margins. However, the precise way in which this occurs is laced in controversy; nowhere is this controversy more apparent than along the Brazilian continental margin, where the origin of a feature called "the Albian Gap" has generated much heated debate over several decades.
In this new, open-access GSA Bulletin article, Christopher A-L. Jackson and colleagues enter this debate, critiquing the geological and geophysical evidence ...
Biologists at UC San Diego have discovered that a tiny single-celled parasite may have a greater-than expected impact on honey bee colonies, which have been undergoing mysterious declines worldwide for the past decade.
In this week's issue of the journal PLOS ONE, (see http://dx.plos.org/10.1371/journal.pone.0126330), the scientists report that a microsporidian called Nosema ceranae, which has been known to infect adult Asiatic and European honey bees, can also infect honeybee larvae. They also discovered that honey bee larvae infected with the microsporidian have reduced ...
Scientists at the University of California, San Diego and the Massachusetts Institute of Technology (MIT) have described a new method for detecting liver cancer metastases in mice. The approach uses over-the-counter probiotics genetically programmed to produce signals easily detectable in urine when liver cancer metastases are present. The results of the new study, published in the May 27 issue of Science Translational Medicine, indicate that genetically-programmed probiotics may be useful for detecting liver cancer metastases early-on in the progression of the disease. ...
A rigorous analysis of more than 3,000 antimalarials purchased in Enugu, Nigeria found 9.3% to be of poor quality, according to new research published in PLOS ONE.
Researchers found 1.2% of the samples to be falsified and 1.3% to be degraded, but raised bigger concerns about 6.8% being of substandard manufacture, leaving patients at risk of not receiving the correct treatment dose and potentially contributing to the development of resistance to the main drug used to treat malaria.
The drug quality team of the Artemisinin-based Combination Therapy (ACT) Consortium ...
PITTSBURGH, May 27, 2015 - Cuts in federal support and unreliable funding streams are creating a hostile work environment for scientists, jeopardizing the future of research efforts and ultimately clinical medicine, according to leaders of the nation's top academic medical centers in today's online issue of Science Translational Medicine.
Led by Arthur S. Levine, M.D., the University of Pittsburgh senior vice chancellor for the health sciences and John and Gertrude Petersen Dean of Medicine, medical school deans from 18 institutions reviewed the financial challenges ...
CAMBRIDGE, MA -- Engineers at MIT and the University of California at San Diego (UCSD) have devised a new way to detect cancer that has spread to the liver, by enlisting help from probiotics -- beneficial bacteria similar to those found in yogurt.
Many types of cancer, including colon and pancreatic, tend to metastasize to the liver. The earlier doctors can find these tumors, the more likely that they can successfully treat them.
"There are interventions, like local surgery or local ablation, that physicians can perform if the spread of disease in the liver is confined, ...
