New Enrollees on Exchanges May Reduce Drug Costs

The Exchange Pulse Report published by Express Scripts predicts that compared with 2014, the year 2015 will see a greater number of younger enrollees signing up on healthcare exchanges, which could potentially drive down drug costs for specialty medications.

Despite this prediction on drug spending, the report found that specialty drug spending in the exchanges increased by 8% over a year: from 34% in the first quarter (Q1) of last year to 42% during Q1 of the current year. Infectious disease, particularly HIV and Hepatitis C, constituted 21% of the pharmacy spend, with HIV being 53% of the specialty claims. The hepatitis C drugs Harvoni (6.4%) and Sovaldi (3.4%) topped the charts for total pharmacy spend, and were followed by the anti-inflammatory antibody Humira (3.2%).

A particular statistic on the report needs attention: only 5% of health exchange members are responsible for 68% of total pharmacy spend, attributable to their use of high-cost medications. While medication non-adherence was higher on the exchanges compared with health plans, individuals on antidepressants fared worse with medication adherence, while hepatitis C patients did better.

The average age of the exchange enrollee has dropped by nearly 4 years, the report states, from 44.5 in Q1 of 2014, to 40.7 years in Q1 of 2015. Significantly, the number of enrollees with drug claims, and particularly specialty claims, reduced significantly between the 2 quarters being compared. The most expensive conditions treated were diabetes, HIV, and inflammatory conditions in Q1 of 2014; this year, hepatitis C replaced inflammatory conditions.

A point to note: families on exchanges, on average, earn $7260 less than families enrolled with health plans.