Healthier patients begin utilizing exchange plans

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, according to a new study by Express Scripts.

Related: Managed care industry needs to know where exchanges are headed

"The Express Scripts Exchange Pulse" report compares prescription medication use among exchange plan enrollees to those who are enrolled in a traditional health plan benefit. The analysis examined medication trends from January 1, 2014 to March 31, 2015, and also compared trends in Q1 2015 to those seen in Q1 2014. The analysis is based on more than 100 million de-identified pharmacy claims administered by Express Scripts during these periods.

Study findings

The study found that new exchange plan enrollees spent less on medications in the first quarter of 2015 compared to the same time one year ago: The number of new exchange plan enrollees who used at least one prescription drug declined 18% in the first quarter of 2015.

However, when evaluating exchange plan medication trends between March 31, 2014 and March 31, 2015, researchers found that spending on high-cost specialty medications grew 24%-compared to 8% growth in traditional health plans-largely attributable to hepatitis C drugs, the third costliest therapy class among exchange plans.

"The findings highlight an opportunity for exchange plans to make medications more affordable and accessible by more closely managing the benefit, encouraging the use of home delivery pharmacy and other proven clinical pharmacy programs, which can help boost medication adherence and foster better disease management,"  Julie Huppert, VP of healthcare reform at Express Scripts, tells Managed Healthcare Executive. "This data is also useful in helping exchange plans identify gaps in risk management, and in preparing future bids."

"If these trends continue, plans can achieve a more balanced risk pool, which will help them sustain benefit offerings in the future," Huppert adds. "That said, the majority of these exchange plan enrollees are among our country’s sickest patients, and need all of the care and support possible to achieve better health."

 

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