Exchange Pulse Report, April 2014

May 12, 2014
Providing the industry’s first national glimpse of the health and medication utilization trends among public exchange members.

HIX April

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Exchange Pulse™ Report Summary

The public health insurance exchanges afford substantial financial opportunities for health plans. At the same time, insurers face challenges associated with managing a new line of business fraught with uncertainty and increased regulation. These early findings are based on an analysis of Express Scripts claims data from health plans participating in the public exchanges (Health Insurance Marketplace) and health plans’ existing commercial book of business. They help identify areas where Express Scripts and health plans can work together to provide greater clinical support for members – many of whom are new to treatment and insurance – to ensure optimal health decisions and outcomes.

While it’s too early to determine whether these trends will hold, this preliminary interpretation is an important benchmark. Through an ongoing series of reports on member health, behavior and medication utilization in exchange plans, Express Scripts will continue to help you better understand this population and successfully compete in the rapidly evolving regulated healthcare marketplace.

Key Findings on the Public Exchange Population

  • 47 percent greater use of specialty medications
  • Nearly 4x higher proportion of medications used to treat HIV
  • Higher utilization of pain medications, anti-seizure medications and anti-depressants
  • Lower utilization of contraceptives and ulcer medications
  • Paid a higher percentage of their pharmacy costs in first 3 months

About the Analysis

The analysis is based on a national sample of more than 1.25 million de-identified pharmacy claims from January 1, 2014, through March 31, 2014, for members enrolled in a public health insurance exchange plan with pharmacy benefit coverage administered by Express Scripts. The exchange plan sample comprised more than 500,000 lives from across the United States. We then compared these claims to those from commercial health plans, also administered by Express Scripts, during the same time period.