In January and February, health insurance exchange enrollees used more specialty medications than those covered by health plans outside of the exchanges, according to a report from pharmacy benefit managed Express Scripts.
About 1.1 percent of total prescriptions covered by exchange plans during those months were for specialty medications, compared with 0.75 percent for commercial health plans outside the Patient Protection and Affordable Care Act marketplaces, according to the report.
The Express analysis — based on a sample of more than 650,000 de-identified pharmacy claims from Jan. 1 through Feb. 28 for exchange enrollees — found more than six in every 1,000 prescriptions covered by exchange plans were for HIV medications, nearly four times higher than the rate for other commercial plans. Additionally, the proportion of pain medication coverage was 35 percent higher in exchange plans, the proportion of anti-seizure medications was 27 percent higher and the proportion of antidepressants was 14 percent higher.
These results suggest the exchange enrollees could be sicker than the insured population outside the new marketplaces. However, the Express analysis only includes data on those whose exchange plans had gone into effect by February. The PPACA exchanges went from 4.2 million enrollees on March 1 to 7.1 million by the open enrollment deadline on March 31. The health status and age distribution of the total enrollee population remains unknown.
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