The Campaign Spot

Pharmacy Managers: 43% of Exchange Enrollees Had Drug Coverage Before Current Plan

You’ve heard a lot of discussion of how many of those who signed up for Obamacare exchanges were previously uninsured, and how many had insurance, had their plan canceled, and had to sign up for a new one. Express Scripts is a giant company (Fortune 100) that manages pharmacies and prescription drug processing. They’ve got some new data to share on how their customers are purchasing or obtaining prescription drugs:

Unlike medical claims that can take several months to process, pharmacy claims adjudicate in real time. And as the country’s largest provider of pharmacy benefits – the health benefit most often used among consumers – Express Scripts is uniquely positioned to leverage our actionable data and provide early insights regarding how patients enrolled in the Public Health Exchanges are using this new benefit…

Approximately 43% of Exchange enrollees were previously enrolled in a plan with Express Scripts in 2013. The remaining 57% could have been uninsured or previously enrolled in a plan with pharmacy coverage administered by another organization.

Now, as they note, this isn’t a perfect measuring stick; in addition to having pharmacy coverage with some other organization, like competitor CVS, some folks who purchased insurance may not have filled a prescription yet. But this is a nice big sample: ‘The analysis is based on a national sample of more than 650,000 de-identified pharmacy claims from Jan. 1, 2014 through Feb. 28, 2014 for patients enrolled in a Public Health Insurance Exchange plan with pharmacy benefit coverage administered by Express Scripts.”

The Urban Institute estimated that 77 percent of the enrollees were previously uninsured; a RAND study put it much lower, at 36 percent. But one factor in the favor of the Express Scripts number is that it isn’t an extrapolation based upon public polling, it’s based on records and data of actual filled prescriptions. 

For those who worry about cost management, those who bought insurance on the exchanges are using more expensive drugs: “Our early analysis reveals that, in January and February, use of specialty medications was greater among Exchange enrollees versus patients enrolled in a commercial health plan. Approximately 1.1% of total prescriptions in Exchange plans were for specialty medications, compared to 0.75% in commercial health plans, a 47% difference. Increased volume for higher cost specialty drugs can have a significant impact on the cost burden for both plan sponsors and patients.”

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