In a first look at pharmacy trends in public health insurance exchange plans, use of specialty medications was greater among exchange enrollees versus patients enrolled in a commercial health plan, according to research presented by pharmacy benefit manager Express Scripts at the Express Scripts Outcomes Symposium in Orlando, Fla.
The analysis is based on a national sample of more than 650,000 de-identified pharmacy claims from Jan. 1 through Feb. 28, 2014, for patients enrolled in a public health insurance exchange plan with pharmacy benefit coverage administered by Express Scripts. The analysis compared these pharmacy claims to those from commercial health plans, with pharmacy coverage administered by Express Scripts, during the same time period.
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. Approximately 1.1 percent of total prescriptions in exchange plans were for specialty medications, compared to 0.75 percent in commercial health plans.
"Increased volume for higher cost specialty drugs can have a significant impact on the cost burden for both plan sponsors and patients," Express Scripts executives said in a statement accompanying the presentation of the analysis. "Despite comprising less than one percent of all U.S. prescriptions, specialty medications now account for more than a quarter of the country's total pharmacy spend."
"We are keeping a close eye on cost-shifting and use of the higher-cost tiers for specialty medications and non-preferred drugs, measuring how quickly these exchange enrollees are meeting their out-of-pocket caps, at which point all costs will be on the health insurer," said Julie Huppert, Express Scripts vice president of healthcare reform. "Our continued reporting and insights on patient behavior and medication utilization in the exchanges will help our clients provide a competitive, affordable benefit amid the persistent uncertainty common with a new regulated market."
Huppert also said the data's initial insights provide "an important benchmark for exchange plans, and help identify areas where Express Scripts and health insurers can provide greater clinical support for patients with chronic and complex conditions to ensure these patients experience the best possible health outcomes."
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