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Survey: Drug benefits 'skin in game' varies widely

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U.S. employers are using the equivalent of everything from scalpels to sabers to great big rocks to attack high prescription drug prices.

Analysts at the Pharmacy Benefit Management Institute (PBMI), an organization that serves the pharmacy benefit manager (PBM) community, have published a batch of data on large employers’ drug benefits management strategies in a new report.

PBMI analysts based the report on results from a survey of 302 employers with about 16 million U.S. health plan enrollees. Ten of the participating employers had 100 or fewer employees when they took the survey in April, but 88 percent had more than 500 employees.

The participating employers told the PBMI that the underlying cost of prescription drugs rose about 10 percent between 2013 and 2014. Although spikes in generic drug prices have been in the news in recent months, generic prices rose just 6.2 percent during that period. The average cost of the new, high-priced “specialty drugs” rose about 19 percent.

Patient Protection and Affordable Care Act (PPACA) coverage rules that took effect in 2014 encourage insurers and employer plans to use deductibles, co-payments and coinsurance amounts to give enrollees “skin the game.” Some health care policy specialists say giving consumers more skin in the game can lower health care spending by pushing consumers to use less health care, and to think harder about prices when they are comparing treatment options.

The PBMI analysts found  that the percentage of participating employers that used drug benefits deductibles to give patients skin in the game increased to 36 percent for this year, from 14 percent in 2014.

At a drug plan with a deductible, the median deductible for single coverage is now $100. The actual deductibles range from $25 up to $5,000. For families, the median is $300, with a range of $50 to $5,000.

Annual out-of-pocket (OOP) drug spending limits range from $350 to $10,000 for single coverage, with a median of $2,000. For family coverage, the annual OOP limits range from $650 to $13,200, with a median of $3,000. The highest family OOP limit is equal to the currrent PPACA limit on cost-sharing amounts at non-grandfathered large-group health plans.

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