By Matthew Arnold, Principal Analyst

So, 7 million. After a shambolic start with the fail foibles, the Affordable Care Act's insurance exchanges signed up just enough people by March 31 to surpass their original goal for 2014 coverage. Only time will tell how warm the water in the risk pool is for insurers and how that impacts premiums, but at first glance, the number of younger enrollees looks doable, if not exactly desirable.

It's a big milestone for the ACA, but healthcare reform is a long and wooly process, not some signal event or legislative action with a tidy beginning and end. We now have proof of concept for the law's insurance provisions, and we can turn to worrying about intangibles like how the health system will absorb the newly-insured, whether employer-sponsored insurance becomes a thing of the past and what happens when high-deductible plans hit the fan. In particular, I'll be following these topics of concern to pharmas:

  • Prescription volumes: Prescriptions seem to have risen by double digits for Medicaid enrollees early in the year. But the vast majority of those scripts will be for generics. Will the law goose sales of branded drugs And will the rise in prescriptions for Medicaid be echoed among exchange enrollees
  • Coverage of pricey drugs: Avalere Health estimates that new enrollees on some exchange plans will pay half the cost of expensive specialty drugs, while patients on traditional employer-sponsored insurance pay no more than a third, and patient advocates are crying foul, saying insurers are tiering these drugs out of reach to control costs.
  • The empowered patient (whether they like it or not): Consumers will be asked to pay more of the costs of their care through high-deductible plans, and to do more of their own shopping for healthcare goods and services, even if they don't have a medical degree. How will they take to these new costs and responsibilities Consumers are already feeling the pain of healthcare costs, as we've seen in our data here at DRG, and it's affecting their treatment decisions. There may be an opportunity for pharmas to help them navigate their options  and to bolster their case with payers through proven pill-plus programs that better adherence and condition management.

This story will be unfolding over years, if not decades. Here's hoping it leads to better outcomes for patients, providers, payers and the healthcare industries. Millions of newly-insured patients in the system is a good start.

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