Impact of health reform on young adult prescription medication utilization

To assess the impact of the Affordable Care Act dependent coverage provision on outpatient prescription expenditures among young adults and to characterize medication types that are prescribed for young adults.

Quasi-experimental.

Using data from the Medical Expenditure Panel Survey from 2007 to 2009 and 2011 to 2013, difference-in-differences (DID) analyses estimated the provision's impact among young adults aged 19 to 25 years versus those aged 26 to 34 years. Five outcomes related to prescription medication access and utilization were evaluated, including whether young adults were unable to get necessary medications in the past year due to cost and whether there were changes in total, out-of-pocket (OOP), and private expenditures and the share of total expenditures paid OOP. DID analyses were also carried out for medication expenditures by class.

There were a total of 19,165 young adults aged 19 to 25 years and 23,892 aged 26 to 34 years. After adjusting for demographic and socioeconomic factors, provision implementation (DID coefficient P ≤.05) was associated with an increase in total expenditures (by 3.8 percentage points), including those paid by private insurance (7.6 percentage points), and decreases in OOP expenditures and the share of total expenditures paid OOP (4.4 and 1.2 percentage points, respectively). Commonly used medications were anti-infectives, central nervous system agents, and hormones. Expenditures significantly increased for anti-infectives and decreased for hormones and psychotherapeutics.

The dependent coverage provision was associated with an increase in prescription medication expenditures, especially for anti-infectives, among young adults. The amount of expenditures paid by private insurers increased, whereas they decreased for OOP spending.