Medicaid ‘Unwinding:’ Much Of The Reduction In Medicaid-Paid Prescriptions Was Offset By Increased Commercial Coverage

Abstract

With the expiration of the Medicaid continuous coverage condition on March 31, 2023, states began returning to regular eligibility renewals in Medicaid and the Children’s Health Insurance Program (CHIP). Because of incompleteness of administrative data and lags in the availability of survey data, there is limited understanding of how this “unwinding” process has affected insurance coverage or access to care. Using data from IQVIA PayerTrak, a large, nationally representative, all-payer pharmacy transactions database, we examined the trends in prescription drug use during the unwinding period. Leveraging state variation in Medicaid coverage termination start dates, we found that although prescriptions paid for by Medicaid or CHIP fell during unwinding, this decline was mostly offset by an increase in commercial-paid prescriptions. Total prescriptions were unchanged, suggesting that the unwinding did not result in reduced access to medications.

Volkov, E., Eloso, J., Bosworth, A., Finegold, K., & Buchmueller, T. C. (2025, May). Medicaid “Unwinding:” Much of the reduction in Medicaid-paid prescriptions was offset by increased commercial coverage. Health Affairs, 44(5), 523–530. https://doi.org/10.1377/hlthaff.2024.01492