While pharmacy benefits utilization was roughly the same during the first half of 2014 for individuals enrolled in public health insurance exchanges and traditional insurance market plans, a new analysis shows the utilization of specialty drugs is much higher in the HIX marketplace.
Specialty drugs account for as much as 38% of the total pharmacy spend for exchange plans, despite being traced to just 1.3% of such claims, compared with 28% for traditional plans. The findings are based on data published by Express Scripts, which manages more than a billion prescriptions a year for tens of millions of patients.
HIX enrollees were found to fill 59% more in specialty scripts than other insured individuals, with those ages 18-34 receiving twice as many of these medications than their peers in a traditional health plan.
Given the increased prevalence of specialty conditions, its vitally important for these exchange plans to provide patients with clinical programs that ensure appropriate management of these complex, high-cost medications, according to Julie Huppert, VP of health care reform at Express Scripts.
See related story: How to help alleviate specialty Rx costs
The researchers also found that prescriptions that treat chronic conditions are priced for HIX enrollees at rates similar to traditional insurance market options, with hypertension identified as the leading category both on and off the exchanges.
Interestingly enough, nearly three of every five specialty prescriptions for individuals enrolled in the exchanges involve an HIV medication. In addition, this group of patients is more than 23 times more likely to be on a hepatitis B script, more than 3.5 times more likely to take a hepatitis C drug and nearly three times more likely to take a pill for non-HIV viral infections.
Huppert noted that HIV patients often need strong clinical support and care to ensure they use their medication properly and remain on therapy.
Nearly half of Americans enrolled in public exchanges have used their pharmacy benefit compared with 55% in traditional plans, according to the second Express Scripts Exchange Pulse Report. The research is based on a national sample of more than 80 million de-identified pharmacy claims administered by Express Scripts through the first seven months of 2014.
Another key finding is that 87% of HIX prescriptions involved generic drugs, whose fill rate outpaced traditional plans by 6%. Huppert said this suggests that HIX plans are being used the way they were intended when participants end up bypassing more costly brand-name drugs.
Other highlights show:
Pain medication use is 39% higher in the exchanges.
Antidepressant use is 12% higher in the exchanges.
Contraceptive use is 32% higher in traditional health plans.
Shutan is a Los Angeles-based freelance writer.
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