Affordable Care Act saves consumers millions on Rx coverage, improves adherence – National Consumers League

By Ayanna Johnson, Health Policy Associate

Late last week, the Congressional Budget Office (CBO) released a report, projecting large savings in health care as a result of the passage of the Affordable Care Act (AC) in 2010. Medicare patients have saved $5 billion in prescription drug costs since 2010. The law improves coverage, by closing the gap—the “doughnut hole” in prescription coverage— after Medicare coverage runs out.  Medicare prescription coverage maxes out at $2,930; closing the gap will save the average Medicare recipient $648.  The Department of Health and Human Services notes that from 2012-2022, Medicare patients with high prescription drug costs will save upwards of $18,000.

Critics of this provision in the ACA have stated that increasing drug coverage will encourage patients to buy their more expensive drugs and decrease the use of generics. While this is a possible scenario, helping individuals afford their medication in order to stay healthy is the primary objective for this provision. In fact, studies have shown that once coverage ends, patients stop taking their medicine—especially their more expensive prescriptions. By increasing coverage individuals can have access to both brand name and generic prescriptions at lower, affordable costs. This seems like a win-win. This provision increases medication adherence, as more individuals are able to afford their drugs.

Increasing adherence is key to lowering overall medical costs. Adhering to medicines and a treatment plan prevents conditions, like heart disease, high blood pressure and diabetes from spiraling out of control. Lowering the price it takes to do this is important for our health as a nation.

The report found for the first time an “offset” of prescription drug coverage—increasing drug coverage lowers overall medical spending costs. The CBO “estimates that a 1 percent increase in the number of prescriptions filled by beneficiaries would cause Medicare’s spending on medical services to fall by roughly one-fifth of 1 percent.” That small savings would result in a net cost of $51 billion in providing the new provisions, instead of the $86 billion originally estimated.

This is good news for consumers and our health care system. Having the numbers from the CBO at the national level to support the widely accepted idea that spending a little more on medication will decrease overall healthcare spending, is the next step to promoting adherence initiatives.

Here at the National Consumers League we are working on a campaign to do just that. Our medication adherence campaign, Script Your Future, aims to increase awareness about the problem of non-adherence and show the benefits of taking medicine as directed. With the help of great tools like wallet cards to list medications and discuss with a pharmacist and text reminders to take medication, the problem of adherence can be addressed.