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Young Adults’ Access to Prescription Drugs Under ACA Mostly Goes to Middle Class, Study in The American Journal of Managed Care® Finds

The American Journal of Managed Care
Posted on: 30 Nov 17

Overall, young adults who stayed on their parents’ health plans due to the Affordable Care Act (ACA) gained access to prescription drugs, but most of the new spending took place in middle-class households, according to a study in the current issue of The American Journal of Managed Care®.

Although Congress has debated repealing the ACA, both parties support keeping the provision that lets adult children stay on family health plans up to age 26. Data presented by Amy Pakyz, PharmD, PhD, MS; Hui Wang, PhD; and Peter Cunningham, PhD; might offer some insight: they show that the change was associated with a 3.8 percent jump in total prescription drug spending among those aged 19-25 in the three years after the change took effect.

The increased drug spending was especially noteworthy among young adults well above the poverty level: in households with incomes at least 300 percent of the federal poverty level (FPL), the authors found an 11.3 percent increase in drug spending for 2011-2013.

Meanwhile, drug spending dropped over the same period for young adults in households at lower income levels: it fell 13.0 percent for those at 101-299 percent of FPL and 13.2 percent for those below 100 percent of FPL.

The authors used data from the Medical Expenditure Panel Survey to compare results from the three years prior to the policy change (2007-2009) to the three years after it took effect (2011-2013). Young adults age 19-25 were the target group, and those age 26-34 were a comparison group.

They call for more research to see if drops in out-of-pocket spending and trends in the types of drugs young adults use lead to improvements in their health. “Further data are needed regarding the impact of the ACA provisions on increased prescription medication access over time, including the specific types of agents being used more frequently and their impact on the health of young adults,” the authors wrote.

Their analysis found an increase in spending by private insurance (7.6 percent) and declining out-of-pocket spending (4.4 percent), as well as a slight decline in the share of drug spending paid out of pocket (1.2 percent).

While much of drug spending for older adults goes to treat chronic disease, more than 80 percent of spending for the young adults fell in six classes: anti-infectives, central nervous system agents, hormones, respiratory treatments, psychotherapeutic, and topical medications.


Pakyz A, Wang H, Cunningham P. Impact of health reform on young adult prescription medication utilization. Am J Manag Care. 2017;23(11):670-676.

About The American Journal of Managed Care ® :

The American Journal of Managed Care ® (AJMC®) is a peer-reviewed, MEDLINE-indexed journal that keeps readers on the forefront of health policy by publishing research relevant to industry decision makers as they work to promote the efficient delivery of high-quality care. is the essential website for managed care professionals, distributing industry updates daily to leading stakeholders. Other titles in the AJMC® family include The American Journal of Accountable Care®, and two evidence-based series, Evidence-Based Oncology™ and Evidence-Based Diabetes Management™. These comprehensive offerings bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. To order reprints of articles appearing in AJMC® publications, please contact Jeff Prescott at 609-716-7777, ext. 331.

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Last updated on: 30/11/2017

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