The introduction of the public health care exchanges in 2014 ushered in a new type of health care consumer. With a full year of data behind us, we have a clearer view into who these people are, their health status and how they’re using medicine. Prime recently presented these findings in our 2014 public exchange report.
In 2014, Prime served more than 1.4 million members enrolled in health coverage through public exchanges — one in every six public exchange users nationwide. We uncovered several key differences in this population when compared to our commercial membership.1 Our 2014 public exchange enrollees:
- Were older, predominantly female and more cost-conscious
- Filled 13.6 percent more prescriptions
- Used specialty drugs 17.3 percent less, but incurred 16.4 percent higher specialty drug spend
- Were almost 250 percent more likely to have hepatitis C or HIV
“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.” - Michael Showalter, senior vice president, Prime Therapeutics
2015 enrollment trends
More than 1.95 million members have already enrolled through the public exchanges for 2015 health coverage with Prime pharmacy benefits. This represents a 41 percent increase over 2014 enrollment. Nationally, public exchange enrollment has also grown, from 8 million in 2014 to 11.7 million in 2015.
This group is not only growing in numbers — their plan choices are also evolving. As the population receives treatment for their high incidence of severe, chronic conditions, their health care needs are leveling out. That’s led to more members choosing plans with lower premiums and higher member cost share.
The future of public exchanges
Together with our Blue Cross and Blue Shield owners and clients, Prime is well positioned for continued success in the growing public exchange marketplace. But legal uncertainties may cloud future success. Portions of the Affordable Care Act are again in front of the U.S. Supreme Court, most notably premium tax credit subsidies. Without these subsidies, many people needing coverage may no longer be able to afford it.
To learn more, please read our 2014 public exchange report.
Internal Prime data. (2014–2015).
United States Department of Health and Human Services. (2014). Health insurance marketplace: Summary enrollment report for the initial annual open enrollment period. Retrieved from http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014apr_enrollment.pdf.