A new sign Obamacare is helping the people who really need it

People enrolled in health plans through the Affordable Care Act exchanges are ramping up their use of prescription medications more rapidly than those in employer or government-sponsored plans, according to a new report from Express Scripts, the largest prescription drug benefits company.

In 2015, people in the exchanges increased their number of prescriptions filled by 8.6 percent, four times the rate of people who receive insurance through commercial plans outside of the exchanges. That, along with price increases, led to a 14.6 percent jump in drug spending for people in the exchanges, nearly three times faster than all drug spending. The findings are based on Express Scripts data, which includes about a third of the pharmacy claims filled by all people insured through the exchanges.

This "has impact for insurers who are going to want to manage this program, given that people who need more care are more likely to join the program," said Glen Stettin, senior vice president and chief innovation officer at Express Scripts. "If they want to continue to have an affordable benefit, they’re going to have to manage this tightly."

Although the growth in spending and use of prescription drugs was faster for patients in the exchanges than for those in commercial plans, the overall amount spent was much lower per person -- $777.27 compared to $1060.75.

The rapid uptake of the prescription drug benefit suggests there was a significant unmet medical need for many people gaining insurance through the exchanges, some of whom could have preexisting conditions and may not have previously had access to medicines. Before 2014, insurance companies could refuse coverage or charge much higher premiums for people with preexisting conditions, a practice largely forbidden under the Affordable Care Act. An April 2014 report from Express Scripts found that people insured through the exchanges were four times more likely to have a prescription for an HIV medication than those in commercial plans.

"In retrospect, we can look back and say that’s no surprise; there are a lot of people who join these plans because they know they have a medical condition and they need care," Stettin said.

The new analysis found that among specialty medications, which made up half of total drug spending in the exchanges, the top three diseases driving spending were HIV, hepatitis C and inflammatory conditions. In contrast, the highest spending in commercial plans for specialty medicines was for inflammatory conditions, multiple sclerosis and cancer. Among traditional therapies on the exchanges, the biggest expenditures were on diabetes and pain and inflammation -- the same as among the commercial population.

Stettin said the surge in prescription drug use from people who may have been motivated to sign up because they need medical care is something every insurer offering a plan in the exchange will have to take into account.

"I think it’s probably going to persist for the next several years," he said. "A lot of younger and healthier people have not yet joined the program; they’re taking their chances."

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