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April 10 2014

Sicker than Average

Patrice J. Lee

New analysis provides some evidence that those who have signed up for ObamaCare tend to be sicker and thus using their medical services at a faster pace. The future doesn’t bode well for a health insurance system that is disproportionately sick. ObamaCare Exchanges need healthy (and young) customers in the mix to balance them out.

The largest pharmacy benefits provider analyzed 650,000 pharmacy claims from the first two months of this year and found that ObamaCare Exchange enrollees are using more specialty medications than those with private healthcare plans. Approximately 1.1 percent of total prescriptions in Exchange plans were for specialty medications, compared to 0.75 percent in commercial health plans, a 47% difference. Six of the top 10 costliest medications used by Exchange enrollees have been specialty drugs. In commercial health plans, only four of the top 10 costliest medications were specialty.

Specialty medications are high-cost medications used to treat complex chronic conditions. Some of the top conditions that these drugs medicate include hypertension/heart disease, high blood cholesterol, diabetes, thyroid disease, and high blood pressure. Interestingly, according to this analysis, the proportion of pain, antidepressant, and anti-seizure medications was higher in the Exchange than in the private market by 25 percent, 14 percent and 27 percent respectively. However, contraceptive use was 31 percent lower – an indication that the Administration was not successful in convincing young women to enroll.

The Daily Caller reports:

Early Obamacare exchange customers are using more specialty medications than those with private health plans by almost half, according to a new analysis, sparking concerns that the health care law’s exchanges may turn out to be less healthy than commercial health plans.

Those figures may appear inconsequential at first, but they have a outsized effect on commercial health care spending. Express Scripts notes that in their 2013 Drug Trend Report, they found that specialty medications, just 0.75 percent of prescriptions, account for over 25 percent of all pharmacy spending in the country.

Once the presumably healthier individuals who waited until March and April to enroll and purchase plans are mixed in, the pool of enrollees will get healthier. But with exchange coverage starting off with such a vast disparity in terms of medication leaves Obamacare with a lot of ground to cover.

This analysis is important for the future costs and sustainability of ObamaCare. Increased volume for higher cost specialty drugs can have a significant impact on the cost burden for both plan sponsors and patients.

We reported yesterday, premiums have been rising under ObamaCare and this new analysis adds to the disturbing news about life under ObamaCare.

As we’ve contended the woeful rollout of healthcare.gov and the insulting PR strategy were not the Achilles heel of the un-Affordable Care Act but just symptoms of a diseased legislation. ObamaCare is a bad deal for Americans raising costs –especially for young people. It’s a roadblock in the job market and has harmful impacts that ripple across our economy.

Independent Women’s Forum’s mission is to improve the lives of Americans by increasing the number of women who value free markets and personal liberty. Sister organization of Independent Women’s Voice.
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