There’s little doubt that a very few, very expensive specialtyprescription drugs are driving up the overall cost ofhealth insurance spending. This cost factor rose tothe surface in yet another study which compared prescription drugspending of those covered by Obamacare exchange insurance toanother group covered via traditional health insurance plans.

The study was performed by Express Scripts Holding Company,which produces the Exchange Pulse report.

The latest report offered two comparisons: one between exchangeand traditional health insurance consumers, and another comparingtrends among exchange plan consumers in 2014 and 2015.

The specialty drug factor came throughmost clearly in the exchange/traditional plan comparison. Among thestudy’s findings:

• Analysis of the exchange plan specialty pharmacy expenditure forthe 15-month period between Jan 1, 2014 and Mar 31, 2015 showed a24 percent increase compared to 8 percent in traditional healthplans.

• The increase was primarily driven by hepatitis C drugs.

• Medication non-adherence was found to be higher in exchange planpatients compared to traditional health plan patients.

• Four of the top 10 costliest conditions for exchange plans —diabetes, high blood pressure, hepatitis C and HIV — showed high medicationnon-adherence.

• Exchange plan costs were 16 percent higher per member per monthcompared to traditional health plans, driven by increased specialtydrug spending.

• Specialty medications accounted for 42 percent of all pharmacyexpenditure among exchange plans.

• Nearly 53 percent of exchange plan specialty pharmacy claimswere for HIV, compared to 20 percent for traditional healthplans.

• The proportion of exchange plan patients with annual medicationcosts over $50,000 was approximately twice the commercially insuredpatients and three times that of Medicaid patients.

The study spotted a positive trend that may tend to reduce theeffects of specialty drugs on cost increases down the road.People who enrolled in exchange plans in 2015 tended to be youngerand healthier than those who enrolled a year earlier.

This trend “enabled them to spend 21 percent and 20 percent lessout-of-pocket on overall medicationsand specialty medications, respectively, compared to those in theyear-ago period. Additionally, exchange plan costs were 36 percentlower per member per month year over year,” the study said. “Thisshould make way for a balanced risk pool, thereby makingmedications more affordable and accessible, and increasing thesustainability of benefit offerings in the long run.”