Enrollees spent less on meds in Q1 2015 vs. Q1 2014

New Health Insurance Exchange plan enrollees spent less on medications in the first quarter of 2015 compared to the same time a year ago, according to the third edition of the Express Scripts Exchange Pulse report.

When compared to the first quarter of 2014, the number of new Exchange plan enrollees who used at least one prescription medication declined 18 percent 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 percent—compared to 8 percent growth in traditional health plans—largely attributable to hepatitis C medications, the third costliest therapy class among Exchange plans.

“While it is encouraging to see data that suggests healthier Americans are enrolling in exchange plans, the research reminds us that many of these patients use this benefit to manage serious, chronic illnesses,” said Julie Huppert, vice president, healthcare reform at Express Scripts. “Exchange plans have an opportunity 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.”

Trends in 2015. In addition to reduced medication use, new Exchange enrollees in Q1 2015 were younger and healthier with 34 percent fewer adjusted specialty pharmacy claims than enrollees in Q1 2014. This resulted in Q1 2015 Exchange enrollees spending 21 percent less out-of-pocket overall on medications, and 20 percent less out-of-pocket on specialty medications compared to Q1 2014. In addition, Exchange plan costs were 36 percent lower per member per month in Q1 2015 compared to Q1 2014.

Additional key trends seen in Q1 2015:

• Spending on hepatitis C medication increased 96 percent compared to Q1 2014.

• Oral contraceptive use increased 29 percent, likely due to the younger average age of Exchange enrollees in Q1 2015.

• While still the most common specialty condition, particularly among enrollees ages 18 to 64, HIV prevalence declined 11 percent compared to Q1 2014.

“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,” said Huppert. “If these trends continue, plans can achieve a more balanced risk pool, which will help them sustain benefit offerings in the future.”

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.

SOURCE: http://lab.express-scripts.com/publications/exchange-pulse-public-exchanges-report-june-2015

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