An Analysis of Prescription Drug Use by Exchange Enrollees in the First Year of Coverage
According to a report from Prime Therapeutics, customers who purchased health insurance on the exchange via the Patient Protection and Affordable Care Act filled 13.6% more prescriptions on average compared with commercial members.
Exchange enrollees used an average of 11.7 prescriptions each year compared with 10.3 prescriptions for those covered via commercial insurance. The average medication costs for enrollees on the exchange was also higher than the commercial space at $85.42 per member, an approximately $3 increase.
The report also indicated that exchange enrollees were 2.5 more likely to have hepatitis C or HIV, which resulted in almost 200% higher prescription drug spending. According to the report hepatitis C medication accounted for 10% of spending for exchange enrollees compared with 4% in the commercial space. Similarly, HIV medication accounted for 9% of spending for exchange enrollees compared with 3% in the commercial population.
The study found that the average age of people purchasing health insur- ance on the exchanges was 42.6 years compared with 34.7 years for enrollees in the commercial market.
“This report confirms our initial expectations that public exchange members would be, on average, older and have more healthcare needs than our commercially insured members,” said Michael Showalter, senior vice president, chief marketing officer, Prime Therapeutics, in a statement.
The company’s analysis is based on more than 13 million exchange claims and more than 143 million commercial claims administered by Prime Therapeutics between January 1, 2014, and December 31, 2014.—Kerri Fitzgerald
