No matter how one tries to spin this, the latest data from Express Scripts points to some very serious adverse selection problems in the Exchanges.
- Exchange enrollees fill 59% more prescriptions for specialty medications than other insured individuals.
- This disparity is especially pronounced in Exchange enrollees ages 18 to 34, who fill twice as many specialty medications as similarly aged individuals in traditional health plans.
- Nearly 3 out of 5 specialty prescriptions filled by Exchange members are for HIV medications.
- Despite accounting for only 1.3% of total pharmacy claims, specialty medications consume 38% of the total pharmacy spend for the Exchange plans. By comparison, only 28% of the total pharmacy spend for traditional health plans is attributed to specialty drugs.
Source:
Express Scripts with a hat tip to
John R. Graham at the NCPA for the pointer.
