Drug spending among new health exchange plan enrollees dropped during the first quarter of 2015 compared with the same period in 2014, according to a new report that seems to reject concerns that healthcare reform would drive up costs because of mandatory coverage of unhealthy Americans.
Pharmacy benefits manager Express Scripts found that the number of new enrollees who used at least one prescription medication during the first quarter of 2015 fell 18% compared to the first quarter of 2014.
The analysis evaluated exchange plan medication trends between March 31, 2014, and March 31, 2015, and found new exchange enrollees tended to be younger and had 34% fewer pharmacy claims for specialty drugs. New enrollees also spent less out-of-pocket on drugs overall during the first quarter of 2015 compared to 2014, and had 36% lower plan costs per member per month in the first quarter of this year compared to the year prior.
The findings may represent a positive trend for the Affordable Care Act toward addressing a major point of contention touted by critics, who have argued the law drives up health costs because the numbers of young, healthy individuals enrolling in health exchange plans were not enough to offset the costs being incurred with the addition of millions of older, sicker Americans.
The report did find however that overall, spending on high-cost specialty medications grew 24% in the first quarter of 2015 among health exchange plans compared to just 8% among traditional health plans. Researchers found the rise was driven largely by spending on hepatitis C medications, which increased 96% compared to 2014. Hep C drugs were the third-costliest therapy class among exchange plans.
“While it is encouraging to see data that suggests healthier Americans are enrolling in exchange plans, the research reminds us that many of these patients use this benefit to manage serious, chronic illnesses,” said Julie Huppert, vice president of healthcare reform at Express Scripts, in a statement. “Exchange plans have an opportunity to make medications more affordable and accessible by more closely managing the benefit, encouraging the use of home delivery pharmacy and other proven clinical pharmacy programs, which can help boost medication adherence and foster better disease management.”
Health exchange plan enrollees remained a major drive of prescription drug costs, according to the report. It found that 5% of exchange plan patients accounted for more than 68% of total drug spending in 2014. Also the share of exchange plan patients with drug costs totaling more than $50,000 in 2014 was more than three times greater than the proportion of Medicaid patients with drug costs exceeding $50,000.
"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," Huppert said. "If these trends continue, plans can achieve a more balanced risk pool, which will help them sustain benefit offerings in the future."
