New public insurance exchange enrollees are starting to use their prescription drug benefits, and so far their per-member costs are looking higher than in the average commercial plan.
The country's largest pharmacy benefits manager, Express Scripts, analyzed claims in January and February from 423,000 public exchange members with plans using the service and found their pharmacy costs this year are about 35 percent higher than for non-exchange commercial members, on a per capita basis.
"This early analysis suggests this new benefit is providing patients with access to the medication they need," wrote Julie Huppert, Express Scripts VP of health reform, in the study. "However, in order to keep this sustainable and affordable for payers and patients, it's important to look at the dynamics around deductibles and out-of-pocket maximums, so each group can plan accordingly."
According to the early data Express Scripts reviewed, exchange members are showing a greater need for speciality medications that treat conditions like arthritis, cancer, hemophilia and multiple sclerosis.
Just over one percent of the total prescriptions Express Scripts filed for exchange members were for speciality drugs, compared to 0.75 percent of non-exchange commercial members served by the company.
Express Scripts found that six of the 10 most expensive drugs in exchange plans are specialty drugs, whereas for non-exchange, mostly group commercial plans, speciality drugs account for four of the 10 most expensive prescriptions.
The cost of speciality drugs promise to be a large challenge for health plans and a potential source of anxiety for their members who need them. While comprising less than one percent of all U.S. prescriptions filled, speciality medications account for more than 25 percent of national drug spending.
So far, exchange members are using more pain medications, seizure treatments, antidepressants and HIV drugs than non-exchange commercial members.
Among the 10 most common drugs used by exchange members with Express Scripts, the top four roughly mirror those used by traditional commercial members: about 16 percent were heart disease medications, about 9 percent high cholesterol meds, 8-9 percent antidepressants and about 7 percent diabetes treatments.
The fifth most common drug used by Express Scripts-covered exchange members in January and February was for thyroid disorders, comprising about five percent of exchange member claims, followed by pain, ulcer and seizure medications, each accounting for about four percent of claims, and contraceptives and anti-hypertensives, accounting for about three percent and two percent respectively.
That deviates a bit from the average commercial membership. Among the non-HIX prescription claims covered by Express Scripts, ulcer treatment medications were the fifth-most common, accounting for just under five percent, followed by contraceptives (4.5 percent), thyroid medications (4.4 percent) and pain, asthma and seizure medications, each accounting for a bit more than three percent.