Exchange Pulse Report, June 2016

Jun 6, 2016
2015 Year in Review: First-ever year-over-year exchange pharmacy data reflects unsettled marketplace

Pulse Report Cover

Click to download the PDF.

Exchange Pulse™ Report Summary

Our latest Exchange Pulse report is the fourth in our series of in-depth investigations into the behavior and medication usage trends of health exchange members and our first ever look at full year-over-year trends.

As expected, given the evolving nature of the exchanges, prescription drug spending between 2014 and 2015 increased at a much higher rate among health exchange plans compared to commercial, Medicare and Medicaid plans.   As with other lines of business, and as seen in previous Pulse reports, specialty costs are a growing concern with the exchange population.  Our first peek at metal level and age data revealed that two-thirds of exchange members chose a silver plan but surprisingly all levels had a similar age distribution.

Key Findings

  • Unlike other populations, utilization – not increasing unit costs –was a primary driver of the exchange’s 14.6% spending increase.
  • Total PMPY spend ($777) remained lower than our commercial population ($906) driven by lower spending on traditional medications.
  • Specialty drugs account for nearly half of all pharmacy spend in the exchanges with HIV and Hep C classes remaining the top contributors.
  • Platinum and gold plans had the highest spend yet silver plans had the greatest spending increase suggesting patients with costly conditions who jumped into the gold and platinum plans in 2014 continued to significantly use the benefit in 2015.

About the Analysis

Utilizing access to approximately 1/3 of all U.S public exchange members, the Express Scripts Exchange Pulse™ Report compares year-over-year trends in prescription medication use among the exchange plan enrollees to those enrolled in a commercial health plan, between 2014 and 2015.