New enrollees in PPACA are healthier andspent less on medication than last year, but they still tend to besicker than those in other health plans.

"While it is encouraging to see data that suggest healthierAmericans are enrolling in exchange plans, the research reminds usthat many of these patients use this benefit to manage serious,chronic illnesses," said Julie Huppert, vice president ofhealth-care reform at Express Scripts, which recently released areport for the first quarter of 2015.

Prescription medication use among exchange and traditionalhealth plan enrollees was compared in the Express Scripts ExchangePulse Report. The analysis is based on more than 100 millionde-identified pharmacy claims administered by Express Script.

Prescription drug use by PPACA enrollees declined by 18 percentin the first quarter of this year, and monthly costs were 36percent lower per member month than during the same period in2014.

However, spending on high-cost medications for complexconditions, known as specialty drugs, grew faster on ACAplans than on other plans. Among the other significantcomparisons with the first quarter of 2014:

• Spending on hepatitis C medication increased by 96 percent.

• Oral contraceptive use increased 29 percent.

• Although still the most common specialty condition, HIVprevalence declined 11 percent

Several other trends emerged. They included thefollowing:

High-cost populations use exchanges. In 2014,just five percent of exchange plan patients accounted for more than68 percent of total prescription drug spending. In addition, theproportion of exchange plan patients with 2014 annual medicationcosts exceeding $50,000 was nearly twice that of commerciallyinsured patients and three times more than Medicaidpatients.

Non-adherence is a concern. Early data suggestthat across most traditional and specialty therapy classes,medication non-adherence was higher in exchange plans compared totraditional health plans:

• Medication non-adherence was high in four of the top 10costliest conditions for exchange plans: diabetes, high bloodpressure, hepatitis C and HIV.

• Thirty-four percent of exchange plan patients with high bloodpressure – the most prevalent traditional condition on theexchanges – were non-adherent to medication therapy, compared to 29percent among traditional health plan patients.

• Twenty-seven percent of exchange plan patients treated for HIV –the most prevalent specialty condition among exchange plans – werenon-adherent to medication therapy, compared to 25 percent ofhealth plan patients.

"While high-cost specialty medication use in exchange plans grewsignificantly throughout 2014, we may be seeing the start of a newchapter with this program, where healthier Americans who use fewerprescription medications are engaging with these plans," Huppertsaid. "If these trends continue, plans can achieve a more balancedrisk pool, which will help them sustain benefit offerings in thefuture."