PHARMACY

Private health exchange an attractive option as enrollment doubles

BY Michael Johnsen

CHICAGO — The online marketplace for private health insurance exchanges doubled enrollment this year to 6 million covered, according to a report by Accenture released Tuesday. 
 
Based on its research, Accenture forecasts that enrollment in private health insurance exchanges will grow to 12 million in 2016 and 22 million in 2017. As previously forecasted, Accenture expects total enrollment in private exchanges to ultimately surpass state and federally funded exchanges, reaching 40 million by 2018.
 
“We remain optimistic that several factors will catalyze enrollment growth in private health insurance exchanges through 2018," said Rich Birhanzel, managing director for Accenture Health Administration Services. “This is especially true as the market matures, employers gain more control of benefit design and evidence continues mounting on the tangible benefits of the model.”
 
Accenture’s findings show midsize employers, defined as companies with 100 to 2,500 employees, contributed most to the adoption of private health exchanges increase.
 
According to Accenture, many employers did not drop coverage in 2015, as initially forecasted. In fact, an Accenture survey found that 76% of consumers with employer-sponsored coverage see health insurance as a primary factor for continuing to work at their current employer, limiting some employers’ ability to drop or defund health coverage. As employers seek a compelling alternative, private exchanges will emerge for some as a compelling model to reduce costs and administrative burden.
 
Private exchange enrollment is expected to accelerate in 2017 due to looming penalties for “Cadillac” Plans. This provision of the Affordable Care Act places a 40% excise tax on high-cost employer health plans beginning in 2018. Research estimates that 38% of large employers (those with more than 2,500 employees) and 17% of American businesses overall will face those penalties in 2018 if action is not taken prior.
 
Other factors driving growth of private health insurance exchanges include continued investments by exchange sponsors in private exchange technology solutions, such as Aetna’s acquisition of bswift and Mercer’s equity investment in Benefitfocus, are expected to drive market maturity and scalability.
 
And the number of large employers who have been on the fence in determining whether to adopt private health insurance exchanges is expected to drop over the next two years due to looming mandates and a maturing market, Accenture added. In addition, Accenture expects that increased compliance requirements mandated by regulations, such as the ACA (section 6055), HIPPA and the Employee Retirement Income Security Act, will drive employers to adopt new models for managing benefits administration.
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PHARMACY

Older public exchange base fills 13.6% more prescriptions than those on commercial plans

BY Michael Johnsen

ST. PAUL, Minn. — During the first year public health exchanges existed, Prime Therapeutics’ members who enrolled in plans on these exchanges filled an average of 11.7 prescriptions, exceeding fills by commercial members by 13.6%, according to a recent report released by Prime Therapeutics
 
Public exchange members were also 2.5 times more likely to have hepatitis C or HIV, driving an almost 200% higher spend on related medicines. Prime’s analysis found that while only 0.7% of public exchange members had hepatitis C or HIV, the amount spent for treating these conditions among this population was significantly higher than the amount spent for commercial members with the same conditions. More specifically, nearly $1 out of every $5 spent on drugs for public exchange members was spent to treat hepatitis C or HIV.
 
However, public exchange members chose lower-cost medicines — generic drugs and 90-day supplies — more frequently than Prime's commercial members. 
 
“We entered the first year of public health exchanges like others in our industry – with many unanswerable questions,” stated Michael Showalter, SVP and chief marketing officer for 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.”
 
Prime's 2 million public exchange members were, on average, eight years older (42.6 years old on average), more likely to be women (56.1%) and had a per member per month cost 4.1% higher than Prime's commerical members. 
 
The full analysis is based on more than 13 million public exchange claims and more than 143 million commercial claims administered by Prime between Jan. 1, 2014 and Dec. 31, 2014. Prime Therapeutics serves more than 26 million people and is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. 
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L.A. Times: USC pilot program illustrates importance of clinical pharmacists

BY Antoinette Alexander

LOS ANGELES — A University of Southern California pilot currently underway at several clinics belonging to nonprofit clinic AltaMed is illustrating the important role that pharmacists can play in improving patient outcomes and easing the burden of the nation’s shortage of primary care physicians, according to a Los Angeles Times article.

The initiative, run by USC clinical pharmacy professor Steven Chen, is currently running at 10 clinics belonging to AltaMed, which serves largely low-income populations in Los Angeles and Orange counties, according to the article.

With team-based medical care as a central feature of the Affordable Care Act, the pilot is proving effective as, according to the article, the clinical pharmacists in the USC program are finding, on average, 10 drug-related problems per patient and are also acting much like a medical counselor.

The clinical pharmacists are paired with patients suffering from chronic illnesses and they typically see their patients once a month. Plus, each visits is typically longer — lasting up to an hour.

According to the LA Times report, early data from the pilot shows that clinical pharmacists can help lower overall healthcare costs by reducing hospitalizations and other costly medical treatments. This is critical as today’s payment models under the Affordable Care Act are shifting to penalize providers if patients do not stay healthy.
 

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