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Specialty drugs 59% more common in exchange plans, study finds


Consumers who enrolled in plans sold on the health insurance exchanges are 59 percent more likely to use pricey specialty drugs, particularly medications that treat HIV and hepatitis C, than people with employer-based coverage, according to a new study from Express Scripts. 

After reviewing a national sample of 5 million drug claims from exchange plan members, the pharmacy benefits manager determined that HIV medications were the most expensive type of treatment that insurers covered in exchange plans, making up more than 11 percent of insurers' total spending.

Of all specialty drug prescriptions, about 57 percent were for HIV drugs, compared to just 20 percent of specialty medications filled for members in employer-based plans.

But it's not just HIV-related medications that were common among exchange enrollees. Total spending for specialty drugs accounted for 38 percent of all drug costs in exchange plans, compared to just 28 percent of employer-based plans.

"They are getting out there and they are accessing it--they are going to their doctor and they are filling medications," Julie Huppert, vice president for healthcare reform at Express Scripts, told the New York Times. "That is great news for patients as well as for the insurance carriers."

Despite the increased usage of HIV drugs and other specialty meds, Express Scripts found that insurers aren't necessarily spending more for their exchange plan members, primarily because those plans have higher out-of-pocket requirements. Insurers are spending 10 percent less on its exchange members' medications than employer plan members, amounting to an average of almost $60 and $67 a month, respectively.

To learn more:
- here's the Express Scripts study
- read the New York Times article

Related Articles:
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Insurers seek to shift more Rx costs to members
More proof that sick enrollees flock to exchanges
Apply value-based design to reduce specialty med costs
High costs for specialty drugs hit patients, payers