Just how sick are exchange plan enrollees?

Hepatitis C use statistics paint a different picture. Express Scripts said the QHP enrollees it served were twice as likely as commercial plan enrollees to be taking hepatitis C drugs. At Prime Therapeutics, QHP enrollees are about 2.5 times more likely to be taking hepatitis C drugs. The hepatitis C drug use ratio could have changed in the past year because of the introduction of major new medications, such as Harvoni.

But Express Scripts says the PPACA Medicaid expansion program has helped utilization rates for expensive specialty drugs at Medicaid plans.

When states used Medicaid expansion money to reach uninsured, low-income adults, they brought in enrollees who were healthy enough not to have qualified for health programs aimed at patients with serious problems.

Because of that shift, at Medicaid plans served by Express Scripts, the likelihood that enrollees ages 20 to 34 would be taking specialty drugs of any kind fell 8.7 percent in 2014.

The likelihood that enrollees ages 35 to 64 would be taking specialty drugs fell 9.9 percent.