Express Scripts sheds light on 2015 public exchange pharmacy trends
ST. LOUIS — New exchange plan enrollees spent less on medications in the first quarter of 2015 compared with the same time a year ago, according to the third edition of the Express Scripts Exchange Pulse report released on Wednesday.
When compared with the first quarter of 2014, the number of new exchange plan enrollees who used at least one prescription medication declined 18% in the first quarter of 2015. However, when evaluating exchange plan medication trends between March 31, 2014 and March 31, 2015, researchers found that spending on high-cost specialty medications grew 24% — compared with 8% growth in traditional health plans — largely attributable to hepatitis C medications, the third costliest therapy class among exchange 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," stated Julie Huppert, VP, healthcare reform at Express Scripts. "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 Express Scripts Exchange Pulse report compares prescription medication use among exchange plan enrollees to those who are enrolled in a traditional health plan benefit. The analysis examined medication trends from January 1, 2014 to March 31, 2015, and also compared trends in the first quarter of 2015 to those seen in the first quarter of 2014. The analysis is based on more than 100 million de-identified pharmacy claims administered by Express Scripts during these periods.
New Trends Emerge in 2015
In addition to reduced medication use, new exchange enrollees in the first quarter of 2015 were younger and healthier with 34% fewer adjusted specialty pharmacy claims than enrollees in the year-ago period. This resulted in first quarter exchange enrollees spending 21% less out-of-pocket overall on medications, and 20% less out-of-pocket on specialty medications compared with the year-ago period. In addition, exchange plan costs were 36% lower per member per month in the first quarter of 2015 compared to the first quarter of 2014.
Additional key trends include:
• Spending on hepatitis C medication increased 96% compared with the year-ago period;
• Oral contraceptive use increased 29%, likely due to the younger average age of exchange enrollees in Q1 2015; and
• While still the most common specialty condition, particularly among enrollees aged 18 to 64, HIV prevalence declined 11% compared with the year-ago period.
"While high-cost specialty medication use in exchange plans grew significantly throughout 2014, we may be seeing the start of a new chapter with this program, where healthier Americans who use fewer prescription medications are engaging with these plans," added Huppert. "If these trends continue, plans can achieve a more balanced risk pool, which will help them sustain benefit offerings in the future."
Specialty Medication Spend is Significant
Data from the 15-month analysis shows specialty medications accounted for 42% of all pharmacy spending among exchange plans. Nearly 53% of exchange plan specialty pharmacy claims were for HIV, compared with 20% for traditional health plans. In addition, exchange plan costs were 16% higher per member per month compared with traditional health plans, largely because of an increased specialty drug spending among exchange plan enrollees.
High-cost hepatitis C drugs Harvoni (ledipasvir/sofosbuvir) and Sovaldi (sofosbuvir) were the two most expensive specialty drugs for exchange plan members. Harvoni, which came to market in October 2014, represented 6.4% of the total pharmacy spend among exchange plans.
Exchange Plans are Paying the Majority of Costs for Patients in High-Cost Populations
There were a higher proportion of patients with high annual medication costs in exchange plans. In 2014, 5% of exchange plan patients accounted for more than 68% of total prescription drug spending. In addition, the proportion of exchange plan patients with 2014 annual medication costs exceeding $50,000 was nearly two times more than commercially insured patients, and more than three times more than Medicaid patients.
Exchange plan patients with more than $50,000 in 2014 annual medications costs paid 2.2% of the costs of their medications out-of-pocket in 2014, and exchange plan patients with annual medications costs at or exceeding $100,000 in 2014 paid 1.7% of their total costs out-of-pocket. Their plans covered the remainder of the costs.
Medication Non-Adherence a Concern for Exchanges
Medication non-adherence affects both exchange and traditional health plan patients; however, early data suggest that across most traditional and specialty therapy classes, medication non-adherence was higher in exchange plans compared to traditional health plans:
• Medication non-adherence was high in four of the top 10 costliest conditions for exchange plans: diabetes, high blood pressure, hepatitis C and HIV;
• 34% of exchange plan patients with high blood pressure — the most prevalent traditional condition on the exchanges — were non-adherent to medication therapy, compared with 29% among traditional health plan patients; and
• 27% of exchange plan patients treated for HIV — the most prevalent specialty condition among exchange plans — were non-adherent to medication therapy, compared with 25% of health plan patients.