Everyone is interested in the health use of people who are signing up for coverage through the reform law’s health insurance exchanges. Pharmacy benefit manager Prime Therapeutics issued a report on characteristics and drug use of exchange enrollees. (Prime Report) The report covers data from 2014, when Prime claims to have covered one-sixth of exchange enrollees. Overall, these people had per member per month drug costs that were 4.1% higher than commercial enrollees. They were on average about 8 years older, with a mean age of 42.6 years, and were more likely to be women. They used generics more than the general commercial population, and this muted their higher drug spending even though they filled 14% more prescriptions. They were more likely to have HIV and hepatitis C, which meant they were heavier users of expensive specialty drugs, with 16% higher specialty spending. 71% selected silver plans, under which they have about 30% cost-sharing. Prime anticipates that more exchange members are going to select bronze plans in the future, which have even higher cost-sharing requirements. The top therapeutic category by spend was diabetes, accounting for almost 11% of total drug spending, which is similar to the commercial population. The next categories were hepatitis C and HIV drugs, at about 9.9% and 8.8% of spend respectively, followed by auto-immune at around 6.8%. The top individual drugs were Solvadi, the hepatitis C drug, Humira, for rheumatoid arthritis, and Atripla for HIV. The top drugs by number of prescriptions were high blood pressure medications, followed by paid and depression, similar to the commercial population. Overall, drug spending on exchange enrollees is not dramatically higher than for the general commercial health insurance population, even though it appears to be a population with a higher percent of patients with expensive to treat diseases.
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The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
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