Latest Report Sheds Light on Exchange Plan Medication Trends

New exchange plan enrollees during the first quarter of 2015 spent less on medications than new enrollees during the same time frame 1 year ago

The latest Express Scripts Exchange Pulse Report indicates that new exchange plan enrollees during the first quarter of 2015 spent less on medications than new enrollees during the same time frame 1 year ago—the number of individuals who used at least 1 prescription medication decreased by 18%.

However when examining exchange plan medication trends on a larger scale between March 31, 2014, and March 31, 2015, researchers found this trend to be a positive one. Spending on high-cost specialty medication increased 24% as compared to an 8% growth in traditional health 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," Julie Huppert, vice president of healthcare reform at Express Scripts, said 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."

The 15-month analysis that compiled more than 100 million de-identified pharmacy claims also discovered other notable trends, including:

  • New enrollees in Q1 of 2015 were found to be healthier and younger
  • Exchange enrollees spent 21% less out-of-pocket overall on medications and 20% less on specialty medications
  • Specialty medications accounted for 42% of all pharmacy spending among exchange plans

Ms Huppert added that these findings may indicate a new shift in exchange plan trends where more, healthier Americans who use fewer prescription medications will engage in these programs, which can “help the plans achieve a more balanced risk pool.”