There’s little doubt that a very few, very expensive specialty prescription drugs are driving up the overall cost of health insurance spending. This cost factor rose to the surface in yet another study which compared prescription drug spending of those covered by Obamacare exchange insurance to another 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 exchange and traditional health insurance consumers, and another comparing trends among exchange plan consumers in 2014 and 2015.

The specialty drug factor came through most clearly in the exchange/traditional plan comparison. Among the study’s findings:

Analysis of the exchange plan specialty pharmacy expenditure for the 15-month period between Jan 1, 2014 and Mar 31, 2015 showed a 24 percent increase compared to 8 percent in traditional health plans.
The increase was primarily driven by hepatitis C drugs.
Medication non-adherence was found to be higher in exchange plan patients 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 medication non-adherence.
Exchange plan costs were 16 percent higher per member per month compared to traditional health plans, driven by increased specialty drug spending.
Specialty medications accounted for 42 percent of all pharmacy expenditure among exchange plans.
Nearly 53 percent of exchange plan specialty pharmacy claims were for HIV, compared to 20 percent for traditional health plans.
The proportion of exchange plan patients with annual medication costs over $50,000 was approximately twice the commercially insured patients and three times that of Medicaid patients.

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

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

Instant Insights /

Specialty drug use higher among exchange plan members

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