Early Drug Claims Suggest Exchange Plan Enrollees Are Sicker Than Average

Offering a first glimpse of the health care needs of Americans who bought coverage through federal and state marketplaces, an analysis of the first two months of claims data shows the new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance.

Offering a first glimpse of the health care needs of Americans who bought coverage through federal and state marketplaces, an analysis of the first two months of claims data shows the new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance.

The sample of claims data - considered a preliminary look at whether new enrollees are sicker-than-average - also found that prescriptions for treating pain, seizures and depression are also proportionally higher in exchange plans, according to Express Scripts, one of the nation's largest pharmacy benefit management companies.

Whether that trend holds true across all insurers - and continues to be the case with the millions who signed up after the first two months of the year - will answer one of the biggest questions facing insurers and proponents of the health law: What is the proportion of sick versus healthy enrollees? The answer is key to whether premiums rise in coming years because insurers need a large number of healthy enrollees to offset the costs of treating the sick.

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Source: Kaiser Health News