Express Scripts Reports Public Exchange Pharmacy Trends - Analyst Blog
Express Scripts Holding Company ESRX announced data from the Exchange Pulse report, which compared prescription medication usage among exchange plan enrollees to patients enrolled in a traditional health plan between the first quarter of 2014 and the first quarter of 2015. The report also compared medication trends for exchange plan enrollees from Jan 1, 2014 to Mar 31, 2015.
According to the report, enrollees in the new exchange plan spent lesser money on medications in the first quarter of 2015 year over year. Apart from an 18% decline in the number of new exchange plan enrollees who use at least one prescription medication, they made 34% lesser adjusted specialty pharmacy claims, compared to the year-ago figure. The new exchange enrollees in the first quarter of 2015 were younger and healthier, which enabled them to spend 21% and 20% 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% lower per member per month year over year.
However, analysis of the exchange plan specialty pharmacy expenditure for the 15-month period between Jan 1, 2014 and Mar 31, 2015 showed a 24% increase compared to 8% in traditional health plans. The increase was primarily driven by hepatitis C drugs (Gilead Sciences’ GILD Harvoni and Sovaldi among others), which, according to Express Scripts, are the third-costliest class of treatment among exchange plans. Moreover, exchange plan costs were 16% higher per member per month compared to traditional health plans, driven by increased specialty drug spending. In fact, data showed that specialty medications accounted for 42% of all pharmacy expenditure among exchange plans. Nearly 53% of exchange plan specialty pharmacy claims were for HIV, compared to 20% for traditional health plans.
Additionally, the report revealed that exchange plans pay majority of costs for the high-cost patient population. In 2014, only 5% exchange plan patients accounted for over 68% of the total prescription drug spending. Exchange plan patients with greater than $50,000 and ≥$100,000 of annual medications costs paid 2.2% and 1.7% of the costs, respectively, while their plans covered the rest of the costs. The proportion of exchange plan patients with annual medication costs over $50,000 was approximately twice the commercially insured patients and thrice Medicaid patients.
Meanwhile, 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.
Express Scripts emphasized that a higher number of healthy Americans are enrolling in exchange plans. 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.
Express Scripts carries a Zacks Rank #3 (Hold). Some better-ranked stocks in the health care sector are AmerisourceBergen Corporation ABC and Avalanche Biotechnologies, Inc. AAVL. While AmerisourceBergen holds a Zacks Rank #1 (Strong Buy), Avalanche carries a Zacks Rank #2 (Buy).
Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report >>
Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report
GILEAD SCIENCES (GILD): Free Stock Analysis Report
AMERISOURCEBRGN (ABC): Free Stock Analysis Report
EXPRESS SCRIPTS (ESRX): Free Stock Analysis Report
AVALANCHE BIOT (AAVL): Free Stock Analysis Report
To read this article on Zacks.com click here.
Zacks Investment Research
