Health Insurance Exchange Plans, Translating Data into Specialty Pharmacy Impact

Health Insurance Exchange Plans, Translating Data into Specialty Pharmacy Impact

The implementation of the Affordable Care Act may be old news for some, but the industry is expressing a keen interest in the implications - many of which are still being uncovered. Data from Health Exchange plans is starting to be collected and analyzed in order to interpret the impact on key stakeholders in the industry. Last week at the World Congress Summit on Specialty Market Access and Channel Optimization, I got a chance to dive into Express Scripts data and discuss the impact of the Health Insurance Exchanges on both patients and specialty pharmacies. If you were not able to join the session, here are the highlights:
 

  • UBC’s parent company, Express Scripts, analyzed data from 27 clients in 40 states, with claims from January 2014 to April 2014.
     
  • As seen in the chart below, a review of this data identified an older demographic than originally expected, heavily skewed to middle and older aged populations. The historically harder to reach, younger demographic is falling short of enrollment projections.

    • Will supporting a demographic this skewed into older age be sustainable?  For specialty pharmacies, the older demographic may mean more co-morbidities to manage and more complex treatment protocols.

Source: Department of Health & Human Services, ASPE Issue Brief, Health Insurance Marketplace: January Enrollment Report and Exchange Pulse ™, Public Exchange Report, April 2014, The Express Scripts Lab® (For additional information visit www.lab.express-scripts.com)

 

  • Claims data indicated that the top 10 therapy classes by claims volume is similar to commercial plans, with a few notable exceptions:

    • Use of pain prescriptions is 35 percent higher in Exchange plans.
    • Use of anti-seizure medications is 27 percent higher in Exchange plans.
    • Use of antidepressants is 14 percent higher in Exchange plans.
    • Use of contraceptives is 31 percent higher in commercial health plans.
       
  • 6 of the top 10 medications in health exchange plans are specialty products (see lists below). This evidence could suggest that previously uninsured patients who are now able to get coverage are driving an influx of higher cost claims to treat specialty chronic conditions such as HIV, multiple sclerosis and cancer.

    • Specialty pharmacies need to be prepared to for the potential increase in patients.


Source: Exchange Pulse ™, Public Exchange Report, April 2014, The Express Scripts Lab® (For additional information visit www.lab.express-scripts.com)

 

The political landscape and impending elections will continue to bring more uncertainty around the Affordable Care Act. What we can draw from the data, however, is that for specialty pharmacies planning and strategy will be key in the coming year. As always, UBC and Express Scripts are monitoring the regulatory landscape and considering the implications for all our audiences. Contact me if you need assistance navigating!

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