an analysis of the first two months of claims data shows the new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance.
The sample of claims data – considered a preliminary look at whether new enrollees are sicker-than-average – also found that prescriptions for treating pain, seizures and depression are also proportionally higher in exchange plans, according to Express Scripts, one of the nation’s largest pharmacy benefit management companies.
This is not surprising. Sicker individuals on average signed up for Exchange policies in October, November, December and the first half of January. They were the motivated enrollees. The less motivated enrollees waited until deadline pressure where they would have to spend money for either something (health insurance) or nothing (mandate penalty) forced a decision.
From a loss management perspective, the relevant question is not whether or not the early enrollee population is sicker than the population that receives insurance through work but whether or not the actual early enrollee population is sicker than projected AND whether or not the late enrollee population is healthy enough to meet projections or slightly healthier than anticipated to cross subsidize the sicker early enrollers.
A population that is sicker than people in work sponsored plans was always anticipated and priced into premiums. Different companies projected and priced the risk differently, but this was a common core assumption. Right now the early evidence is showing that most companies got it pretty close.