This could definitely speed up a death spiral. This is from Kathryn Mayer at Benefits Pro:
... [B]ased on their medication usage, PPACA enrollees are sicker than patients off the exchanges, often requiring specialty drug prescriptions.
The pharmacy benefit manager said that six of the top 10 costliest medications used by exchange enrollees have been specialty drugs — such as those used to treat HIV/AIDS, autoimmune disorders and cancer. In commercial health plans, four of the top 10 costliest medications were specialty.
“Our early analysis reveals that, in January and February, use of specialty medications was greater among exchange enrollees vs. patients enrolled in a commercial health plan,” Express Scripts said in its report. “Approximately 1.1 percent of total prescriptions in exchange plans were for specialty medications, compared to 0.75 percent in commercial health plans, a 47 percent difference.”
Analysis also found the proportion of medications specifically to treat HIV was nearly four times higher in the exchanges than in commercial health plans.
Also higher in exchange plans were the proportion of pain medications (35 percent higher in exchanges than in commercial plans), anti-seizure medications (27 percent higher) and antidepressants (14 percent higher). The proportion of contraceptives, however, was 31 percent lower in exchange plans. ...
