Medicaid Expansion Leads to More Breast Cancer Treatment

Guideline-recommended hormone treatments for women with breast cancer increased in states that expanded Medicaid, a new AHRQ-funded study has found. In the study, published in Health Services Research, researchers examined Medicaid data from 2011 to 2018. They found that Medicaid-financed hormonal therapy prescriptions increased by 27.2 per 100,000 women compared with states that did not expand Medicaid under the Affordable Care Act (ACA). The ACA expanded Medicaid eligibility, but not every state chose to expand its Medicaid program. Previous studies have not found any change in breast cancer screening rates between expansion and nonexpansion states. This study is the first to demonstrate that Medicaid expansion states experienced increased prescription fills for breast cancer hormonal therapy among women enrolled in Medicaid compared with states that did not expand their Medicaid programs. Access the abstract.

The Effect of Medicaid Expansion on Prescriptions for Breast Cancer Hormonal Therapy Medications

Johanna Catherine Maclean 1 2 3, Michael T Halpern 4, Steven C Hill 5, Michael F Pesko 6

Affiliations

PMID: 32301119
DOI: 10.1111/1475-6773.13289

Abstract

Objective: To quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees.

Data source/study setting: Medicaid State Drug Utilization Database (SDUD) 2011-2018, comprising the universe of outpatient prescription medications covered under the Medicaid program.

Study design: Differences-in-differences and event-study linear models compare population rates of tamoxifen and aromatase inhibitor (anastrozole, exemestane, and letrozole) use in expansion and nonexpansion states, controlling for population characteristics, state, and time.

Principal findings: Relative to nonexpansion states, Medicaid-financed hormonal therapy prescriptions increased by 27.2 per 100 000 nonelderly women in a state. This implies a 28.8 percent increase from the pre-expansion mean of 94.2 per 100 000 nonelderly women in expansion states. The event-study model reveals no evidence of differential pretrends in expansion and nonexpansion states and suggests use grew to 40 or more prescriptions per 100 000 nonelderly women 3-5 years postexpansion.

Conclusions: Medicaid expansion may have had a meaningful impact on the ability of lower-income women to access effective hormonal therapies used to treat breast cancer.

Keywords: Medicaid; breast cancer; differences-in-differences; prescription medications; public insurance.