Exchange Enrollees Have Higher Use of Specialty Meds

In January and February, the use of specialty medications was greater among exchange enrollees than commercial health plan enrollees, according to an analysis by Express Scripts. About 1.1% of total prescriptions in exchange plans were for specialty medications, compared to 0.75% in commercial health plans — a 47% difference. Increased volume for higher cost specialty drugs can have a significant effect on the cost burden for plan sponsors and patients. More than six of every 1,000 prescriptions in the exchange plans was for a medication to treat HIV, which is nearly four times higher in exchange plans than in commercial health plans. About 43% of Exchange enrollees were previously enrolled in a plan with Express Scripts in 2013. The remaining 57% could have been uninsured or previously enrolled in a plan with pharmacy coverage administered by another organization.
Patients in exchange plans paid a greater percentage of their pharmacy costs in the first two months of their plan, compared to those in commercial plans. As a result, health insurers’ per-member pharmacy costs are nearly 35% higher for their commercial plans versus their Exchange plans. For more information, visit

Last Updated 10/20/2021

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