Pharmacy availability is often compromised in low-income communities, which are more likely to be in “pharmacy deserts” and affected by pharmacy closures. Lack of access to pharmacies negatively impacts access to medications, but few studies have examined the policy determinants of pharmacy availability.
Under the Affordable Care Act, expansion of Medicaid eligibility increased insurance coverage and Medicaid-paid prescriptions, without changing prescription volume from other sources. This may have increased pharmacy revenue while encouraging pharmacy entry or discouraging closure, especially in areas with more newly insured patients.
Dr. Pragya Kakani, assistant professor of population health sciences, Dr. William Schpero, assistant professor of population health sciences, and colleagues conducted a study to examine the association between the expansion of Medicaid eligibility under the Affordable Care Act and pharmacy access. Published in JAMA Health Forum, the study compared data from states that expanded Medicaid between 2014 and 2016 with data from non-expanding states as of 2022.
In areas with the highest pre-expansion adult uninsurance rates, Medicaid expansion was associated with a 5.7 percent increase in pharmacy availability after five years relative to similar areas in non-expanding states, which experienced a 7.4 percent decrease in pharmacy availability over 2011 to 2021. These results indicate that projected Medicaid coverage losses under the One Big Beautiful Bill Act could harm health care access, both for patients losing coverage and those served by affected health care facilities.
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