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New PPACA enrollees healthier but use it for serious illnesses

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New enrollees in PPACA are healthier and spent less on medication than last year, but they still tend to be sicker than those in other health plans.

“While it is encouraging to see data that suggest healthier Americans are enrolling in exchange plans, the research reminds us that many of these patients use this benefit to manage serious, chronic illnesses,” said Julie Huppert, vice president of health-care reform at Express Scripts, which recently released a report for the first quarter of 2015.

Prescription medication use among exchange and traditional health plan enrollees was compared in the Express Scripts Exchange Pulse Report. The analysis is based on more than 100 million de-identified pharmacy claims administered by Express Script.

Prescription drug use by PPACA enrollees declined by 18 percent in the first quarter of this year, and monthly costs were 36 percent lower per member month than during the same period in 2014.

However, spending on high-cost medications for complex conditions, known as specialty drugs, grew faster on ACA plans than on other plans. Among the other significant comparisons with the first quarter of 2014:

  • Spending on hepatitis C medication increased by 96 percent.

  • Oral contraceptive use increased 29 percent.

  • Although still the most common specialty condition, HIV prevalence declined 11 percent

Several other trends emerged. They included the following:

High-cost populations use exchanges. In 2014, just five percent of exchange plan patients accounted for more than 68 percent of total prescription drug spending. In addition, the proportion of exchange plan patients with 2014 annual medication costs exceeding $50,000 was nearly twice that of commercially insured patients and three times more than Medicaid patients.      

Non-adherence is a concern. Early data suggest that across most traditional and specialty therapy classes, medication non-adherence was higher in exchange plans compared to traditional health plans:

  • Medication non-adherence was high in four of the top 10 costliest conditions for exchange plans: diabetes, high blood pressure, hepatitis C and HIV.

  • Thirty-four percent of exchange plan patients with high blood pressure – the most prevalent traditional condition on the exchanges – were non-adherent to medication therapy, compared to 29 percent among traditional health plan patients.

  • Twenty-seven percent of exchange plan patients treated for HIV – the most prevalent specialty condition among exchange plans – were non-adherent to medication therapy, compared to 25 percent of health plan patients.

“While high-cost specialty medication use in exchange plans grew significantly throughout 2014, we may be seeing the start of a new chapter with this program, where healthier Americans who use fewer prescription medications are engaging with these plans,” Huppert said. “If these trends continue, plans can achieve a more balanced risk pool, which will help them sustain benefit offerings in the future.”

See also:

Just how sick are exchange plan enrollees?

The health whisperer: Private exchanges are for real


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