Key survey results include:
• Plans using a four-tier design increased from 17% to 25% between 2010 and 2011. Nearly 50% of large employers (more than 20,000 lives) now have a four-tier plan design.
• Specialty copays increased by 37% in 2011. The average specialty copay grew from $61 in 2010 to $84 in 2011. Nearly one in four employers now place specialty drugs on a fourth tier.
• PBM pricing pressure in mail is mounting as the average discount off AWP rose by 10 percentage points for generics dispensed through mail,increasing from 58% in 2010 to more than 68% in 2011.
• Reduced coverage of specialty pharmaceuticals on the medical side is on the rise as 24% of employers now restrict coverage of specialty drugs under the medical benefit, up from 12% in 2010.
“Employers are implementing prescription management approaches consistent with their strategy for overall medical benefits. As a result, the complexity of cost-sharing continues to grow driven by increased use of four-tier plans and coinsurance designs which require additional member education,” said Brenda Motheral, PhD, Executive Director of the PBMI, in a press release.
The 2011 survey was completed by 274 employers and other plans representing 5.2 million members.
Copies of the report are available at www.pbmi.com.
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