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 http://lab.express-scripts.com/insights/government-programs/first-look-health-exchange-medication-utilization.