Early ACA enrollees more likely to be sicker, suffer from chronic disease

April 10, 2014

The first people to enroll in the health insurance exchanges created under the Affordable Care Act were more likely to be sicker or suffering from a chronic disease than the average patient, according to a new study that analyzed prescription drug use.

 

The first people to enroll in the health insurance exchanges created under the Affordable Care Act were more likely to be sicker or suffering from a chronic disease than the average patient, according to a new study that analyzed prescription drug use.

Express Scripts examined more than 650,000 pharmacy claims submitted for exchange enrollees from January through February and compared the claims to those made from patients on commercial health plans during the same time frame. It found that patients on the exchanges had a 35% higher proportion of pain medications filled and 27% more anti-seizure medications.

The analysis showed that six of the top 10 costliest medications used by exchange patients were specialty drugs, including Atripla to treat H.I.V. and Copaxone to treat multiple sclerosis. That’s compared with patients on employer plans, where four of the top 10 costliest medications were specialty drugs.

Exchanges enrollees also had fewer contraceptives filled. The proportion was 31% lower than for those on commercial health plans.

The top four conditions, which were based on the prescription volume, were the same for both types of insurance plans: hypertension/heart disease, high cholesterol, depression, and diabetes.

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced at a Senate Finance Committee hearing on Thursday that 7.5 million people have enrolled in the exchanges. Although open enrollment for 2014 officially ended March 31, the deadline was extended to April 15 for those who had not completed the application process by the end of March.

In January, HHS said that adults ages 18 to 34, accounted for about 24% of exchange patients. But it has not released demographic information for those who enrolled closer to the deadline.