New Express Scripts Analysis Reveals Trends Among Health Exchange Members

ST. LOUIS, Oct. 8, 2014 /PRNewswire/ -- Nearly half of Americans enrolled in a Public Health Insurance Exchange plan, including those who waited until April 2014 to enroll, have already used their pharmacy benefit, according to new data published today by Express Scripts (NASDAQ: ESRX).

This usage rate is similar to that of traditionally insured Americans (55 percent) during the same time period, even though traditionally-insured Americans are more likely to have been insured since January and more familiar with health insurance.

"It's important to see this type of consistency in how new exchange members are using their pharmacy benefit, especially those who enrolled more recently," said Julie Huppert, Express Scripts Vice President of Healthcare Reform. "They are paying premiums, seeing their physicians and filling prescriptions."

These findings are included in the second Express Scripts Exchange Pulse™ Report, which compares prescription drug utilization within the Exchange plans to trends in traditionally insured populations. The comprehensive analysis is based on a national sample of more than 80 million de-identified pharmacy claims administered by Express Scripts between January 1, 2014 and July 31, 2014.

Exchange Members Use More Generics

The analysis shows that 87 percent of Exchange plan prescriptions filled through July were for generic medications. This generic fill rate outpaced that of the traditionally insured population by six percent.

"The Silver-rated plans – those with lower premiums but higher out-of-pockets costs for brand-name medications – have been the most popular among consumers on the Exchanges, particularly among those eligible for subsidies," said Huppert. "By preferring generic medications over more expensive brand-name alternatives, these members are using their plans in the way they were designed."

Limited Differences for Non-Specialty Chronic Conditions

Exchange enrollees are obtaining medications to treat traditional chronic conditions, such as heart disease and diabetes, at rates similar to those insured individuals who did not purchase insurance on the Exchanges. Both groups filled more prescriptions to treat hypertension than any other condition.

Key differences between the groups include the following:

• Use of contraceptives is 32 percent higher in traditional health plans.
• Use of pain medications is 39 percent higher in the Exchange plans.
• Use of antidepressants is 12 percent higher in the Exchange plans.

Higher Utilization of Specialty Medications within the Exchanges

Exchange enrollees fill 59 percent more prescriptions for specialty medications than other insured individuals. This disparity is especially pronounced in Exchange enrollees aged 18-34, who fill twice as many specialty medications than similarly aged individuals insured in a traditional health plan.

Despite accounting for only 1.3 percent of the number of total pharmacy claims, specialty medications consume 38 percent of the total pharmacy spend for the Exchange plans. By comparison, only 28 percent of the total pharmacy spend for traditional health plans is attributed to specialty drugs.

Nearly three out of every five specialty prescriptions filled by an Exchange member is for an HIV medication. In addition, compared to Exchange enrollees not taking an HIV medication, Exchange patients currently taking an HIV medication are:

• More than 3.5 times more likely to take a hepatitis C medication.
• More than 23 times more likely to take a hepatitis B medication.
• Nearly three times more likely to take a medication for non-HIV viral infections.

"Given the increased prevalence of specialty conditions, it's vitally important for these Exchange plans to provide patients with clinical programs that ensure appropriate management of these complex, high-cost medications," said Huppert. "Express Scripts' HIV specialist pharmacists have in-depth knowledge and experience helping patients with HIV manage their complex therapies and the co-morbidities commonly associated with their condition. These patients often need strong clinical support and care to ensure they use their medication properly and remain on therapy."

For more information about these findings, please visit: http://Lab.Express-Scripts.com/Insights/Government-Programs/New-Analysis-Health-Exchange-Medication-Trends.

About Express Scripts Government Programs

Express Scripts has more than a decade of proven experience and deep capabilities providing pharmacy benefit management services to plan sponsors working in regulated healthcare markets. Express Scripts' Government Programs employees are dedicated to serving Medicare, Medicaid and public exchange marketplace plans and members. Regulated-markets clients benefit from Express Scripts' unmatched compliance rigor, consultative partnership and clinical care innovations. Express Scripts offers Medicare, Medicaid and public exchange clients a wide range of innovative products and consultative solutions that deliver a more tightly managed, cost effective benefit while improving healthcare quality for those we serve.

About Express Scripts
Express Scripts manages more than a billion prescriptions each year for tens of millions of patients. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. Express Scripts uniquely combines three capabilities — behavioral sciences, clinical specialization and actionable data — to create Health Decision Science℠, our innovative approach to help individuals make the best drug choices, pharmacy choices and health choices. Better decisions mean healthier outcomes.

Headquartered in St. Louis, Express Scripts provides integrated pharmacy-benefit management services, including network-pharmacy claims processing, home delivery, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

For more information, visit Lab.Express-Scripts.com or follow @ExpressScripts on Twitter.

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SOURCE Express Scripts