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Specialty drug use high among exchange enrollees


New enrollees who purchased coverage through state and federal marketplaces are more likely to use specialty medications, such as those used to treat HIV/AIDs and hepatitis C, than people enrolled in commercial health plans, Express Scripts research finds.

For those enrolled in state and federal plans, six of the 10 priciest medications used have been specialty drugs, according to the analysis of more than 650,000 de-identified pharmacy claims from Jan. 1 through Feb. 28 of this year. For those enrolled in commercial plans, four of the 10 priciest meds were specialty.

In exchange plans, specialty meds accounted for about 1.1 percent of total prescriptions, compared to 0.75 percent in commercial plans. The analysis finds that six in every 1,000 prescriptions were for an HIV drug, while Sovaldi--the costly drug to treat hepatitis C, came in second for total spending.

"This is a very early analysis that starts to tell the story of how exchange enrollees are using this new benefit," Julie Huppert, Express Scripts vice president of healthcare reform, said today in a statement.

If these findings remain consistent across insurers, the industry could determine the proportion of sick versus healthy enrollees. And since the White House extended the deadline for rate filings until the end of May, healthy consumers now have more time to sign up at the last minute, whch allows insurers to better assess their risk pools, FierceHealthPayer previously reported.

Insurers anticipated sicker enrollees during the first year of exchanges, and factored this assumption into this year's premiums. However, if they guessed wrong, next year's rates may soar, according to Kaiser Health News.  What's more, it appears the sick were more motivated to endure the glitchy and at-times unreliable HealthCare.gov website, the article noted.

"One has to be cautious in interpreting these results," Dan Mendelson, founder and CEO of Avalere Health, told Kaiser Health News. "There was a rush of young, relatively healthy people who signed up in March and April. Having said that, it seems to imply that if you have HIV, you will sign up for this benefit," he said.

For more:
- here's the Express Scripts announcement
- read the Kaiser Health News article

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