The Importance of Prescription Drugs to Midlife Medicaid Enrollees

Outpatient prescription drugs are a complex and expensive benefit within state Medicaid programs. Federal rules require that, if states offer this benefit, they must cover a significant range of approved drugs. However, states have some flexibility in how they administer the benefit. Accordingly, states have looked for ways to tailor the benefit to contain costs. At the same time, without this benefit, many Medicaid enrollees could struggle to have access to and afford these drugs, leading to poor health outcomes and higher health costs in the future.

This Fact Sheet builds on the AARP Public Policy Institute (PPI) 2023 report, Medicaid in Midlife: A Profile of Enrollees Ages 50 to 64. It considers how adults ages 50 to 64 enrolled in Medicaid, hereafter “midlife Medicaid enrollees,” use one Medicaid benefit: outpatient prescription drugs. It examines a set of baseline trends (who fills prescriptions, where they live, and how often they fill prescriptions), the types of drugs midlife Medicaid enrollees fill, and the impact of state expansion of Medicaid on prescription drug use among this population. It includes national maps showing variations among the states, and highlights data from four states—Idaho, Maine, Utah, and Virginia—that expanded Medicaid between 2017 and 2020.

Key Takeaways

• Just over half of the 11 million adults ages 50 to 64 enrolled in Medicaid (i.e., midlife Medicaid enrollees) in 2020 used one or more prescription drugs.
• Midlife Medicaid enrollees who used outpatient prescription drugs filled 3.3 prescriptions a month on average.
• Between 2017 and 2020, midlife Medicaid enrollees filled more prescriptions for cardiovascular drugs than for any other therapeutic class.
• Midlife Medicaid enrollees living in states that have expanded their Medicaid programs after the passage of the Affordable Care Act are more likely to use at least one prescription drug, but on average they use fewer drugs per month than those living in states that have not expanded Medicaid.
• The profile of prescription drug use among midlife Medicaid enrollees provides a baseline that can help inform efforts to update this important program Ensuring Medicaid’s prescription drug benefit is meaningful to midlife adults.

This profile in midlife Medicaid enrollees’ use of prescription drugs shows that Medicaid’s outpatient prescription drug benefit is a significant resource for millions of midlife enrollees. Those who use prescription drugs— filling just over three prescriptions a month, on average—are typically using products to treat serious chronic health conditions that will progress without treatment, such as cardiovascular disease. 

The information in this Fact Sheet helps in constructing a foundational profile of prescription drug use among midlife Medicaid enrollees. It also sets up further research that could help policymakers, Medicaid officials, and managed care organizations better understand who uses the benefit, and how, as they continue to look for ways to update and change the program benefits in the face of rising drug prices and increasing state Medicaid spending.