By Matthew Arnold, Principal Analyst

Seems a little unfair that the career epitaph for Kathleen Sebelius stint as HHS chief is doomed to be an HTTP 404 Error message on Healthcare.gov, but that's politics for you. However, her resignation comes amid some hopeful signs for the Affordable Care Act perhaps most notably, for pharmas, an ExpressScripts analysis of prescription claims data which found that, as of January and February, exchange enrollees were getting significantly more prescriptions filled for specialty drugs than were Americans with traditional employer-based insurance. Specialty drugs accounted for around 1.1% of exchange plan prescriptions, versus .75% for commercial health plans.

Those numbers may seem small, but that's a 47% difference. Of course, you can read that data a couple ways.

Pessimists might point out that this means the initial risk pool skews older, sicker and more expensive, and that's surely true, though it's not exactly news. The more bearish on Obamacare might note that small fluctuations in uptake of pricey specialty drugs can have a dramatic impact on healthcare spending, as specialty medications accounted for fewer than 1% of scripts last year but more than a quarter of overall spending. ExpressScripts, which has raised a red flag over the soaring price of some specialty drugs, like Gilead's Sovaldi, has forecast a 63% increase in spending on those drugs through 2016, driven by innovative Hepatitis C treatments.

But an optimist might say this means that exactly the people who most needed insurance coverage people with chronic illnesses that had previously been locked out or priced out of the insurance market are getting it, and that they're getting the drugs they need to keep them from getting sicker (and more expensive when they wind up in the ER).

The pessimists undoubtedly have a point, and there will be plenty of skirmishing between payers and pharmas over drug prices, formulary restrictions and co-pays for plan enrollees. But the risk pool is likely to improve for insurers as time goes on, and the very legitimate concerns about the cost of these medicines to the taxpayer must be weighed against the benefits to those patients that were previously untreated.

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