Patients insured through public exchanges are less likely to comply with their meds

Patients enrolled in public health exchange plans have a harder time with medication adherence than those in traditional health plans, according to a report released in June by Express Scripts.

Medication nonadherence was higher in patients with public exchange plans in the areas of depression, diabetes, hypertension, HIV, and hepatitis C compared with traditional health plan patients, according to a 15-month analysis of more than 100 million pharmacy claims between January 1, 2014 and March 31, 2015.

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Nonadherence rates

Antidepressant use ranked as the second most common drug utilized by public exchange patients (8.90% of prescriptions) with a nonadherence rate of 44%. For traditional health plan patients, antidepressants were the third most common therapy (7.92% of prescriptions) used with a nonadherence rate of 41%, according to the report.

Medications used for diabetes treatment in the public exchange plans were the fifth most utilized (7.48% of Rxs) with a similar nonadherence rate to antidepressants at 43%. Those patients with traditional health plans had a 39% nonadherence rate and the diabetes drugs ranked as the fourth most common therapy (7.70% of Rxs).

Medication claims for hypertension and heart disease were ranked as the most common drug therapies for both public exchange patients (21.17% of Rxs) and for traditional plan patients (20.09% of Rxs). However, medication nonadherence was 34% in the public exchange group compared with 29% in the traditional plan group.

Costliest categories

HIV is one of the costliest and one of the most prevalent specialty conditions among public exchange patients. The medication nonadherence rate for HIV medications was 27% among public exchange patients compared with 25% among traditional plan patients.

“Data from the 15-month analysis shows specialty medications accounted for 42 percent of all pharmacy spending among exchange plans. Nearly 53 percent of exchange plan specialty pharmacy claims were for HIV, compared with 20 percent for traditional health plans,” according to Express Scripts.

Hepatitis C was one of the three most costly drugs used by patients in public exchange plans. “Harvoni [ledipasvir/sofosbuvir], which came on the market in October 2014, represented 6.4% of the total pharmacy spend among exchange plans,” Express Scripts reported.

Also, the medication nonadherence rate for hepatitis C medications was higher among public exchange patients (16%) compared with traditional plan patients (12%).