The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications

Johanna Catherine Maclean, Michael T. Halpern, Steven C. Hill, Michael F. Pesko

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)399-410
Number of pages12
JournalHealth Services Research
Issue number3
StatePublished - Jun 1 2020


  • Medicaid
  • breast cancer
  • differences-in-differences
  • prescription medications
  • public insurance

ASJC Scopus subject areas

  • Health Policy


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