Early ObamaCare Exchange Enrollees Are Much, Much Sicker Than Other Insureds

Express Scripts, the country’s largest provider of pharmacy benefits, has released its First Look at medication utilization in the exchanges.

Variety of Medicine in Pill Bottles[U]se of specialty medications was greater among Exchange enrollees versus patients enrolled in a commercial health plan. Approximately 1.1% of total prescriptions in Exchange plans were for specialty medications, compared to 0.75% in commercial health plans, a 47% difference. Increased volume for higher cost specialty drugs can have a significant impact on the cost burdens…Specialty medications now account for more than a quarter of the country’s total pharmacy spend.

In total spend, six of the top 10 costliest medications used by Exchange enrollees have been specialty drugs. In commercial health plans, only four of the top 10 costliest medications were specialty.

For example, “more than six in every 1,000 prescriptions in the Exchange plans were for a medication to treat HIV. This proportion is nearly four times higher in Exchange plans than in commercial health plans.”

This First Look covers claims from January and February, so it does not include people who signed up at the end of open enrollment in March. The latter may be healthier people who responded to the Administration’s unprecedented sales and marketing campaign.

Comments (18)

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  1. Perry says:

    “The latter may be healthier people who responded to the Administration’s unprecedented sales and marketing campaign.”

    Yep, I’m sure all those young invincibles were scrambling to sign up.

  2. Eisenhower says:

    Partially because healthy and young people prefer to save the money.

  3. Thomas says:

    Probably because the early enrollees were people that needed health insurance and are older. Isn’t this why there was a death spiral fear earlier in the year?

  4. Martin T says:

    One of the main campaigns of the exchanges was aimed for those individuals with HIV. The administration spent a lot on advertisement to enroll them. It is not surprising that the figure is so high for drugs related to this treatment. This should be expected as individuals with HIV might have faced restrictions to enroll in private insurance before the law came into effect.

    • James M. says:

      HIV medications are costly. For them, access is probably easier and costs are lower.

  5. Buddy says:

    “Early ObamaCare Exchange Enrollees Are Much, Much Sicker Than Other Insureds”

    Shouldn’t be a surprise

  6. Gabriel J says:

    I really don’t expect for much change in the data. Even with the spike in the last month, most of those who sought coverage were those individuals that needed to be insured. The vast majority of the population is ignorant about the law and their possible consequences.

    • James M. says:

      I would anticipate seeing a disproportionate amount of people opting to pay the annual uninsured fee than to sign up for ObamaCare.

      • Bill B. says:

        You would save lots of money and have a better safety net then the government can provide.

    • Walter Q. says:

      I don’t know if I would call them ignorant. Maybe uninterested or uninformed. I am uninterested in ObamaCare, which is why I was not an early enrollee.

  7. Erik says:

    I find it interesting that Express Scripts would make this claim and not CuraScipts? Express Scripts is the mail order RX for formulary drugs while Curascripts is the Specialty Rx distributer?

    • John R. Graham says:

      Express Scripts is not just mail order. Its analytic capabilities are extremely powerful. I had an appointment with my optometrist yesterday and was surprised to learn that he was wired into Express Scripts, although he does not dispense Rx.

  8. Devon Herrick says:

    This information is far more important than people realize. Even if Express Scripts didn’t have patient data, it could easily analyze the medications dispensed and figure out the average health status of exchange enrollees compared to off-exchange enrollees. We’ve heard a lot lately about the exchange and the number of individuals who are signing up. At 7.1 million, the Obama Administration all but declared victory on April 1st. But the real battle for the survival of the exchanges (and ObamaCare) is being fought behind the scenes. It’s not liberal vs. conservative. What will determine the future of the exchanges is whether the cost of sick enrollees causes premiums to skyrocket and precipitate an adverse selection death spiral.