Dive Brief:
- Two new studies have evaluated prescription medication usage after enrollment in the state health exchanges and found that people on the exchanges got about the same amount of prescriptions filled as those on employer-based plans, but were more likely to be treated for serious, chronic conditions like HIV and hepatitis C. Between January 1 and July 31 of this year, 56.5% of the drugs prescribed in public plans were for HIV as opposed to 19.8% through employers. Specialty medications purchased on the exchanges account for 1.3% of overall volume, but nearly 40% of total cost.
- Generally, the studies show that people signing up on the exchanges tended to be slightly older and to have serious medical conditions, as many expected, but insurers aren't necessarily paying more for them. Exchange members have more out-of-pocket costs than enrollees in employer-based plans. According to The New York Times, insurers are paying 10% less, or an average of $59.83 a month per member, for medications prescribed in the exchanges.
- Comparing employer and exchange plans is not a perfect science, however, because coverage options on the exchanges varied widely. It would be safe to say, though, that a large number of people who signed up for the exchanges were those that had been locked out of the health system because of pre-existing conditions like HIV.
Dive Insight:
Many of the individuals on the public exchanges are likely people working part-time or in jobs where health benefits are not available. But the healthcare exchanges are an evolving program and the dynamic may quickly be shifting. Wal-Mart announced this week that they will no longer be providing insurance for their part-time workforce. And more companies may be looking to shift the cost of health insurance elsewhere. It was also expected that people signing up for the plans in the first year of operation would be ones formerly without insurance and needing a lot of care. This should level off over time.