As employee benefit budgets remain tight, employers are adopting plan design changes that reduce drug benefit coverage and improve pricing according to findings from the 2011-2012 Prescription Drug Benefit Cost and Plan Design Report published by the Pharmacy Benefit Management Institute (PBMI).
The 2011 survey was completed by 274 employers and other plans representing 5.2 million members. 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 1 in 4 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.
This report is a valuable reference tool for all industry stakeholders, covering the full spectrum of pharmacy benefits and continually changing market dynamics. New to this year’s report are rebate figures for retail 90 and specialty prescription claims