Prime Insights

REPORT: Defining parallels

New report dives deeper into public exchange use and spend patterns

Prime Therapeutics | Dec. 23, 2015

Through our partnership with Blue Cross and Blue Shield Plans, Prime has proudly served nearly 2 million public exchange members — more than 1 in 6 of those who enrolled. As the Health Insurance Marketplace (HIM) matures into its second year, we’ve discovered a number of interesting parallels — and a few significant differences — in the way public exchange members use medicines and accumulate drug spend.

Prime has released a new report outlining some of the patterns that have emerged. Defining parallels looks back at the first 18 months of public exchange data and presents:

  • A comparison of midyear spend and utilization patterns in 2014 versus 2015
  • A clearer view of the HIM population and a longitudinal look at 18-month trends
  • A prospective look at the impact of PCSK9 inhibitors

Some of our key findings include:

  • Year-over-year utilization remained largely the same, but spend differed significantly, largely due to the introduction of blockbuster hepatitis C medicines
  • Public exchange members filled 23.5 percent more prescriptions, on average, than commercial members
  • Because of the older average age of the HIM population, PCSK9 inhibitors could add between $1.34 to $10.31 per member per month, depending on the level of utilization management

As the HIM matures, we’re dedicated to continually analyzing and evaluating this new population of health care consumers and how they use medicine. We don’t know what the future may hold for the HIM in 2016 and beyond, but our commitment to helping our clients control total costs — so we can help people get the medicine they need — remains strong.

View full report.