Rx Drug Spending Down Among New Exchange Enrollees

New enrollees in the Affordable Care Act’s exchanges in 2015 spent less on prescription drugs and tended to be younger than new enrollees last year, according to a report from pharmacy benefits manager Express Scripts, Modern Healthcare reports.

The analysis looked at trends in exchange plan medications between March 31, 2014, and March 31, 2015.
Report Findings

The report found the number of new enrollees who used at least one prescription medication during the first quarter of 2015 declined by 18% compared with the same period in 2014.

The report also found that new enrollees in 2015 tended to be younger and had 34% fewer pharmacy claims for specialty drugs than new enrollees in 2014. During Q1 2015, new enrollees also spent less on out-of-pocket medications and had 36% lower health care plan costs per member per month, compared with the Q1 2014 (Ross Johnson, Modern Healthcare, 7/2).

However, exchange enrollees incurred 16% higher per-member costs per month when compared with individuals covered by non-ACA plans. Further, exchange enrollee spending for specialty drugs increased by 24% over last year, compared with 8% growth for individuals covered by non-ACA plans (Sullivan, The Hill, 7/1).

Meanwhile, exchange enrollees were a significant contributor to prescription drug spending, with 5% of exchange plan enrollees accounting for 68% of total drug spending in 2014. The share of those individuals with prescription drug costs totaling more than $50,000 in 2014 was also more than three times greater than that of Medicaid enrollees with drug costs exceeding $50,000.

Express Scripts Vice President of Health Care Reform Julie Huppert said the data reflect a positive trend overall for exchange plans. She said, “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.” She added, “If these trends continue, plans can achieve a more balanced risk pool, which will help them sustain benefit offerings in the future” (Modern Healthcare, 7/2).

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