title: Early Marketplace Enrollees Were Older And Used More Medication Than Later Enrollees; Marketplaces Pooled Risk.
abstract: Little is known about the health status of the 7.3 million Americans who enrolled in insurance plans through the Marketplaces established by the Affordable Care Act in 2014. Medication use may provide an early indicator of the health needs and access to care among Marketplace enrollees. We used data from January-September 2014 on more than one million Marketplace enrollees from Express Scripts, the largest pharmacy benefit management company in the United States. We compared the characteristics and medication use between early and late Marketplace enrollees and between all Marketplace enrollees and enrollees with employer-sponsored insurance. Among Marketplace enrollees, we found that those who enrolled earlier (October 2013-February 2014) were older and used more medication than later enrollees. Marketplace enrollees, as a whole, had lower average drug spending and were less likely to use most medication classes than the employer-sponsored comparison group. However, Marketplace enrollees were more likely to use medicines for hepatitis C and particularly for HIV.
authors.affiliation: Julie M. Donohue (jdonohue@pitt.edu) is an associate professor in the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, in Pennsylvania.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
authors.affiliation: Eros Papademetriou is manager of outcomes research at the Eliassen Group, in Somerset, New Jersey.
authors.forename: Eros
authors.initials: E
authors.lastname: Papademetriou
authors.affiliation: Rochelle R. Henderson is a senior director of research at Express Scripts, in St. Louis, Missouri.
authors.forename: Rochelle R
authors.initials: RR
authors.lastname: Henderson
authors.affiliation: Sharon Glave Frazee is vice president of research and education at the Pharmacy Benefits Management Institute, in Plano, Texas.
authors.forename: Sharon Glave
authors.initials: SG
authors.lastname: Frazee
authors.affiliation: Christine Eibner is a senior economist at the RAND Corporation in Arlington, Virginia.
authors.forename: Christine
authors.initials: C
authors.lastname: Eibner
authors.affiliation: Andrew W. Mulcahy is an associate policy researcher at the RAND Corporation in Arlington.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Mulcahy
authors.affiliation: Ateev Mehrotra is an associate professor in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Ateev
authors.initials: A
authors.lastname: Mehrotra
authors.affiliation: Shivum Bharill is an undergraduate student at the University of Michigan, in Ann Arbor.
authors.forename: Shivum
authors.initials: S
authors.lastname: Bharill
authors.affiliation: Can Cui is a doctoral candidate in economics at the University of Texas at Austin.
authors.forename: Can
authors.initials: C
authors.lastname: Cui
authors.affiliation: Bradley D. Stein is a senior natural scientist at the RAND Corporation and an associate professor of psychiatry at the University of Pittsburgh School of Medicine.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
authors.affiliation: Walid F. Gellad is an adjunct scientist at the RAND Corporation, an assistant professor of medicine in the Division of General Medicine at the University of Pittsburgh, and a staff physician with the Department of Veterans Affairs, all in Pittsburgh.
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D018166:Health Care Reform; D019538:Health Care Surveys; D062265:Health Insurance Exchanges / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D055553:Prescription Drugs / Q000627:therapeutic use*; D014481:United States; D055815:Young Adult
chemical_list: D055553:Prescription Drugs
keywords: Health Reform; Insurance Coverage < Insurance