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


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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