Magazine article Drug Topics

Triggered by ACA, Health-Plan Changes Are Mushrooming

Magazine article Drug Topics

Triggered by ACA, Health-Plan Changes Are Mushrooming

Article excerpt

The Affordable Care Act (ACA) is drastically changing the way patients and employers pay for healthcare and prescriptions, said speakers at this year's NACDS Total Store Expo, which took place in Boston, Aug. 23-26. And, they pointed out, pharmacists still have a lot to leam about the effects of the ACA on employer health plans.

In fact, when asked whether they understand the major provisions of the ACA, only 5.3% of pharmacists surveyed for a report titled "Research in Social and Administrative Pharmacy" said they "strongly agree."

To help shed some light, Katy Spangler, senior vice president of health policy for the American Benefits Council, and Michael Johnsrud, BS Pharm, PhD, senior vice president of Avalere Health PhD, briefed show attendees on aspects of the healthcare legislation in a presentation titled "ACA's Impact on Community Pharmacies."

Higher numbers

For example, Avalere Health predicts that pharmacy-covered enrollment in managed care organizations (MCOs) will increase by 37% between 2013 and 2016. And Express Scripts found that, from January through March, patients enrolled in healthcare exchanges had a 47% greater use of specialty medications than patients enrolled in commercial plans. " [There was] a greater volume in costs due to depression, pain, and seizure medications, and a higher cost-sharing as well. You think about who is using the exchanges: patients who are [having] a little more complex [health issues]," Johnsrud said.

In addition, the Centers for Medicare and Medicaid Services (CMS) estimates that 6.7 million individuals joined Medicaid between January and May of this year, a likely consequence of the ACA. "We are still seeing pretty hefty increases in the Medicaid population. Some of it could be related to the economy... We think it could be the exposure: the marketing and promotion under the ACA," Johnsrud said.

More business

Pharmacists may also obtain more business from Medicare patients because of the ACA. "The way that Medicare is structured to pay physicians, there is a really big emphasis on specialty care. As you see more people get insurance because of the healthcare law, you will see that become more of an issue, in that it is hard to see a primary care doctor," Spangler said. …

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