Symphony finds Rx hike from Medicaid claims

Don Otterbein
Don Otterbein

The Affordable Care Act has spurred double-digit increases in demand for pharmaceuticals, new data suggest. Prescription claims for Medicaid patients increased in January by 10% and in February by 14% over the same periods last year.

The study, by market research firm Symphony Health Solutions, links the three million or so who have newly signed up for Medicaid with the upturn. (Enrollment in private insurance under the ACA has reached 7.5 million, the Obama administration said, although that total did not include Medicaid enrollment.)

“Even with Medicaid expansion less than three months old, we're starting to see notable increases in Medicaid prescription claims,” said Don Otterbein, SVP marketing and product management, Symphony Health Solutions. “We expect this trend to continue.”

Symphony said the Medicaid data are a combination of third-party Medicaid and state-run Medicaid data from its managed care research product, which utilizes claims data from more than 42,000 unique retail pharmacies.

The Wall Street Journal, citing CMS stats, reported that about 61 million people were on Medicaid as of the end of February, vs. 58 million from a period of July to September 2013—an increase of three million enrollees since the start of the health law's open enrollment period October 1.

The study also uncovered that average out-of-pocket cost for contraceptives has dropped more than 58% since 2012. That data come from a look at commercial payers, female patients and the drug class for contraceptive agents.

You must be a registered member of MMM to post a comment.

Email Newsletters


Specialty medicines continue to be a hot category, one in which spending has surged behind products that treat medicine's most complex diseases. This eBook lays out the needs and hurdles along the specialty drug pathway, explaining how stakeholders are working to get meds into patients' hands and ease their experience. Click here to download.