One pharmacy benefit manager (PBM) says the public exchange plan enrollees it serves are much sicker than enrollees in employer-sponsored health plans.
But the PBM, Prime Therapeutics Inc., has published one bit of data suggesting that the enrollees could be healthier than exchange plan enrollees at a competitor, Express Scripts Inc. (NYSE:ESRX).
The PBM, Prime Therapeutics, came up with its statistics by analyzing 13 million Patient Protection and Affordable Care Act (PPACA) exchange qualified health plan (QHP) claims it received in 2014, and 143 million commercial plan claims.
About 0.6 percent of the QHP enrollees took HIV drugs, compared with 0.016 percent of the employer plan enrollees. The QHP enrollees were 3.75 times more likely to be taking HIV drugs.
Express Scripts reported in October that the QHP enrollees it served were 4.5 times more likely to be taking HIV drugs.