Enrollees on the Exchanges Fill More and Costlier Prescriptions

Patients enrolled in plans on the public health insurance exchange filled more prescriptions than commercial members during the first year of enrollment under Affordable Care Act, according to a report from Prime Therapeutics.

Prime’s members who enrolled in plans on the health exchanges filled an average of 11.7 prescriptions, which was 13.6% more than their counterparts in commercial plans. Spending for members on the public exchanges was almost 200% higher because these individuals were 2.5 times more likely to hepatitis C or HIV, according to Prime’s data.

“We entered the first year of public health exchanges like others in our industry—with many unanswerable questions,” Michael Showalter, senior vice president and chief marketing officer for Prime, said in a statement. “This report confirms our initial expectations that public exchange members would be, on average, older and have more health care needs than our commercially insured members. Having this full year data will help us better serve our members and clients.”

Prime analyzed more than 13 million public exchange claims and more than 143 million commercial claims (from members enrolled through employers or other organizations) administered between January 1, 2014, and December 31, 2014.

Overall, members on the public exchange were older (average age of 42.6 years) and predominantly female (56.1%), which was expected, according to Mr Showalter’s letter in the report.

Only 0.7% of public exchange members, compared with 0.2% of commercial members, are living with hepatitis C or HIV, which highlights the huge impact on spending these drugs have. Nearly $1 out of every $5 spent on drugs was spent on treatment for these 2 diseases. Nearly a quarter of specialty spend in the public exchange went to Sovaldi compared with 9.9% in the commercial population.

However, public exchange members were more cost-conscious, and chose lower-cost medications more frequently than commercial members and were more likely to choose a 90-day supply. Members on the public exchange had out-of-pocket costs that were 14.3% of overall spend, compared with 19.4% for commercial members.

A majority of members on the public exchange chose silver plans in 2014, but that is changing. So far, Prime’s 2015 data has shown a 135% increase in enrollment in catastrophic plans and a 70% increase in bronze plans.

“As their health care needs level out, more people are selecting catastrophic and bronze plans,” Tom Hoffman, vice president and general manager of the individual market at Prime, wrote in the report. “This would suggest that unsubsidized public health exchange members are identifying another opportunity to save through lower premiums.”