Health exchanges fuel prescriptions

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ST. PAUL — Pharmacy benefits manager Prime Therapeutics says that its members who enrolled in public health exchanges during their first year of existence filled an average of 11.7 prescriptions, exceeding fills by commercial members by 13.6%.

Duane Reade pharmacist tech_featuredPublic exchange members were also 2.5 times more likely to have hepatitis C or HIV, driving an almost 200% higher spend on related medicines. These findings and other insights on Prime’s public exchange members and their drug use were released last month in what Prime says is the first full-year pharmacy benefits trend report for this population.

“We entered the first year of public health exchanges like others in our industry — with many unanswerable questions,” said Michael Showalter, senior vice president and chief marketing officer at Prime. “This report confirms our initial expectations that public exchange members would be, on average, older and have more health care needs than our commercially insured members. Having this full-year data will help us better serve our members and clients.”

The analysis compares trends among Prime’s public exchange members (those enrolled in a public health insurance exchange plan) to trends in Prime’s commercially insured population (members enrolled in health insurance plans provided by an employer or other organization).

The full analysis is based on more than 13 million public exchange claims and more than 143 million commercial claims administered by Prime between January 1 and December 31, 2014.

In the report, Prime’s leaders also provide their perspective on what the future holds for public exchanges. They touch on the growth of public exchanges as well as legal uncertainties, economic conditions and market trends that will likely influence this market.

Meanwhile, the Centers for Disease Control and Prevention said that the number of uninsured U.S. residents is down by over 11 million individuals since the passage of the Affordable Care Act. Although that would be the lowest level in more than 15 years, it would still leave an estimated 37 million people without health ­insurance.

The most significant change occurred in comparing 2013 with the first nine months of last year, when the number of uninsured individuals declined by an estimated 7.6 million.



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