Express Scripts Analysis Reveals First Look at Medication Utilization Trends Among Public Health Insurance Exchange Enrollees

 Express Scripts Analysis Reveals First Look at Medication Utilization Trends
               Among Public Health Insurance Exchange Enrollees

Early Data Shows Greater Use of Specialty Medications in Exchange Plans vs.
Commercial Health Plans

PR Newswire

ORLANDO, Fla., April 9, 2014

ORLANDO, Fla., April 9, 2014 /PRNewswire/ --In a first look at pharmacy
trends in Public Health Insurance Exchange plans, use of specialty medications
was greater among Exchange enrollees versus patients enrolled in a commercial
health plan, according to new research presented today by Express Scripts

Express Scripts, St. Louis, Missouri. (PRNewsFoto/Express Scripts)

"This is a very early analysis that starts to tell the story of how Exchange
enrollees are using this new benefit," said Julie Huppert, Express Scripts
vice president of healthcare reform. "Our initial insights provide an
important benchmark for Exchange plans, and help identify areas where Express
Scripts and health insurers can provide greater clinical support for patients
with chronic and complex conditions to ensure these patients experience the
best possible health outcomes."

In total spend, six of the top 10 costliest medications used by Exchange
enrollees have been specialty drugs. In commercial health plans, only four of
the top 10 costliest medications were specialty. Approximately 1.1 percent of
total prescriptions in Exchange plans were for specialty medications, compared
to 0.75 percent in commercial health plans. Increased volume for higher cost
specialty drugs can have a significant impact on the cost burden for both plan
sponsors and patients. Despite comprising less than one percent of all U.S.
prescriptions, specialty medications now account for more than a quarter of
the country's total pharmacy spend.

The analysis, presented today at the Express Scripts Outcomes Symposium in
Orlando, is based on a national sample of more than 650,000 de-identified
pharmacy claims from January 1, 2014 through February 28, 2014 for patients
enrolled in a Public Health Insurance Exchange plan with pharmacy benefit
coverage administered by Express Scripts. The analysis compared these pharmacy
claims to those from commercial health plans, with pharmacy coverage
administered by Express Scripts, during the same time period.

Key Insights

  oMore than six in every 1,000 prescriptions in the Exchange plans were for
    a medication to treat HIV. This proportion is nearly four times higher in
    Exchange plans than in commercial health plans.
  oThe top 10 therapy classes by claims volume for Exchange enrollees and
    those in a commercial health plan were largely similar, with a few notable

       oThe proportion of pain medication was 35 percent higher in Exchange
       oThe proportion of anti-seizure medications was 27 percent higher in
         Exchange plans.
       oThe proportion of antidepressants was 14 percent higher in Exchange
       oThe proportion of contraceptives was 31 percent lower in Exchange

  oApproximately 43 percent of Exchange enrollees were previously enrolled in
    a plan with Express Scripts in 2013. The remaining 57 percent could have
    been uninsured or previously enrolled in a plan with pharmacy coverage
    administered by another organization.
  oPatients in Exchange plans in the first two months paid a greater
    percentage of their pharmacy costs compared to those enrolled in
    commercial plans. As a result, health insurers' per-member pharmacy costs
    so far this year are nearly 35 percent higher for their commercial plans
    vs. their Exchange plans.

"We are keeping a close eye on cost-shifting and use of the higher-cost tiers
for specialty medications and non-preferred drugs, measuring how quickly these
Exchange enrollees are meeting their out-of-pocket caps, at which point all
costs will be on the health insurer," said Huppert. "Our continued reporting
and insights on patient behavior and medication utilization in the Exchanges
will help our clients provide a competitive, affordable benefit amid the
persistent uncertainty common with a new regulated market."

For more information about these findings, please visit

About Express Scripts Government Programs

Express Scripts has more than a decade of proven experience and deep
capabilities providing pharmacy benefit management services to plan sponsors
working in regulated healthcare markets. Express Scripts' Government Programs
employees are dedicated to serving Medicare, Medicaid and public exchange
marketplace plans and members. Regulated-markets clients benefit from Express
Scripts' unmatched compliance rigor, consultative partnership and clinical
care innovations. Express Scripts offers Medicare, Medicaid and public
exchange clients a wide range of innovative products and consultative
solutions that deliver a more tightly managed, cost effective benefit while
improving healthcare quality for those we serve.

About Express Scripts

Express Scripts manages more than a billion prescriptions each year for tens
of millions of patients. On behalf of our clients — employers, health plans,
unions and government health programs — we make the use of prescription drugs
safer and more affordable. Express Scripts uniquely combines three
capabilities — behavioral sciences, clinical specialization and actionable
data — to create Health Decision Science℠, our innovative approach to help
individuals make the best drug choices, pharmacy choices and health choices.
Better decisions mean healthier outcomes.

Headquartered in St. Louis, Express Scripts provides integrated
pharmacy-benefit management services, including network-pharmacy claims
processing, home delivery, specialty benefit management, benefit-design
consultation, drug-utilization review, formulary management, and medical and
drug data analysis services. The company also distributes a full range of
biopharmaceutical products and provides extensive cost-management and
patient-care services.

For more information, visit or follow @ExpressScripts
on Twitter.

Jennifer Luddy
Office: 201-269-6402

David Myers

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SOURCE Express Scripts

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