Obamacare customers could be sicker than the rest of the country, have higher speciality drug use


Early Obamacare exchange customers are using more specialty medications than those with private health plans by almost half, according to a new analysis, sparking concerns that the health care law’s exchanges may turn out to be less healthy than commercial health plans.

Express Scripts, the largest pharmacy benefits provider, analyzed 650,000 pharmacy claims from January and February of this year, and found that exchange enrollees are using more specialty medications at far higher rates. The proportion of specialty medications to overall prescriptions in exchange plans was 47 percent higher than across commercial health plans.

On Obamacare exchanges, 1.1 percent of total prescriptions were specialty, while in private plans, 0.75 percent of all prescriptions were for specialty medications.

Those figures may appear inconsequential at first, but they have a outsized effect on commercial health care spending. Express Scripts notes that in their 2013 Drug Trend Report, they found that specialty medications, just 0.75 percent of prescriptions, account for over 25 percent of all pharmacy spending in the country.

“Increased volume for higher cost specialty drugs can have a significant impact on the cost burden for both plan sponsors and patients,” Express Scripts found.

And as it turns out, a whole host of costly specialty drugs are much more commonly purchased via exchange plans. The proportion of HIV medication is almost four times higher on the exchanges than in commercial health plans; pain medication is 35 percent more common on the exchanges; anti-seizure medication use is 27 percent higher; and antidepressants are 14 percent higher.

The proportion of contraceptives, however, was 31 percent lower on Obamacare exchanges than in the commercial health industry, potentially because exchanges have failed to attract enough young participants, while commercial health plans have been markedly more successful.

Express Scripts’ early results aren’t entirely conclusive, as the study examines just those who purchased Obamacare coverage early enough for it to be active in January and February. Those that were most eager to sign up for health insurance as soon as possible are more likely to be sicker and require more specialty medications.

Once the presumably healthier individuals who waited until March and April to enroll and purchase plans are mixed in, the pool of enrollees will get healthier. But with exchange coverage starting off with such a vast disparity in terms of medication leaves Obamacare with a lot of ground to cover.

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