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Obamacare Patients Use More Birth Control, But Fewer Prescriptions In Year Two

Written by: | readers@forbes.com | Dated: Tuesday, June 30th, 2015

In what may slow the growth of premiums for Americans purchasing coverage on public exchanges under the Affordable Care Act, a new report shows 2015 enrollees using fewer prescriptions than those who signed up for coverage in 2014.

Express Scripts (ESRX), one of the nation’s largest managers of prescription drugs, said the number of new exchange plan enrollees using at least one prescription dropped 18% in the first quarter of this year compared to the first quarter of 2014.

Meanwhile, usage of prescriptions like birth control pills increased, another sign younger people are signing up for subsidized coverage under the health law, the report’s authors say. Use of oral contraceptives jumped 29% in the first quarter of this year compared to the year ago quarter for newly enrolled in public exchange plans.

“This could mean that you are starting to see those who are healthier on average coming into public exchanges and buying insurance,” Julie Huppert, vice president of healthcare reform at Express Scripts said in an interview.

Prescription Usage In Exchange Plans Under The Affordable Care Act. Source: Express Scripts

Critics of the health law have argued that it will be difficult to keep costs under control if more sick people sign up for coverage than those that are healthy. Insurers and pharmacy benefit managers need healthy people paying their premiums to help pay the costs of the sick.

“It will balance out that risk pool if the trend continues and we really do continue to see lower utilization,” Huppert added. “You need healthier people to make the risk pool work. It’s encouraging.”

The authors of the report based their analysis on more than 100 million prescription claims processed by Express Scripts from January 1, 2014 to March 31 of this year.

Express Scripts manages pharmacy benefits for large employers as well as insurance companies including Anthem (ANTM) and certain other Blue Cross and Blue Shield plans. Express Scripts manages drug benefits for one-third of Americans who purchased coverage on public exchanges.

Though the report indicates newly insured enrollees are trending younger, people who purchase exchange plans are sicker than those in traditional health plans and tend to cost the system more. Those buying on the exchanges were often uninsured or unable to purchase coverage in the past because plans could deny them prior to the health law if they had a preexisting condition.

The report indicates that those with illness are using their drug benefits on exchange plans. For example, more than half, or 53% of all specialty pharmacy claims were for drugs to treat the HIV virus compared to 20% for traditional plans.

Such specialty drugs to treat HIV or Hepatitis C are big cost drivers. Exchange plan costs were 16% higher per member per month compared to traditional health plans, Express Scripts said. Hepatitis C pills sold by Gilead Sciences (GILD) and Abbvie (ABBV) cost $1,000 or more per pill for several weeks of treatment.

Source: Forbes

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