Those who enrolled in health coverage through the exchanges aren’t as healthy as some would like, according to new data.
Analysis from Express Scripts shows that, based on their medication usage, Patient Protection and Affordable Care Act (PPACA) enrollees are sicker than patients off the exchanges, often requiring specialty drug prescriptions.
The pharmacy benefit manager said that six of the top 10 costliest medications used by exchange enrollees have been specialty drugs — such as those used to treat HIV/AIDS, autoimmune disorders and cancer. In commercial health plans, four of the top 10 costliest medications were specialty.
“Our early analysis reveals that, in January and February, use of specialty medications was greater among exchange enrollees vs. patients enrolled in a commercial health plan,” Express Scripts said in its report. “Approximately 1.1 percent of total prescriptions in exchange plans were for specialty medications, compared to 0.75 percent in commercial health plans, a 47 percent difference.”
Analysis also found the proportion of medications specifically to treat HIV was nearly four times higher in the exchanges than in commercial health plans.
Also higher in exchange plans were the proportion of pain medications (35 percent higher in exchanges than in commercial plans), anti-seizure medications (27 percent higher) and antidepressants (14 percent higher). The proportion of contraceptives, however, was 31 percent lower in exchange plans.
Increased volume for higher cost specialty drugs can have a significant impact on the cost burden for both plan sponsors and patients, analysts said. Carriers’ per-member pharmacy costs so far this year are nearly 35 percent higher for their commercial plans versus their exchange plans, the report found.