Drug Prices After the Midterms: Five Crucial Implications of Pharmacy Benefit Design

After Tuesday's election, House minority leader Nancy Pelosi pointed to "reducing the cost of prescription drugs" as a legislative priority. But addressing patient affordability issues will require more than decrying “high drug prices.”

Today, I highlight five implications of these benefit designs on patient affordability, out-of-pocket costs, and perceptions of prescriptions prices. My observations are based on Employer Pharmacy Benefits in 2018: More Tiers, Greater Coinsurance, and Lots of High-Deductible Plans, in which I summarized companies’ 2018 prescription drug coverage for their employees.

As I explain below, many aspects of employers’ plans are unfriendly to patients with serious medical conditions and to those who face coinsurance and high-deductible plans. What’s more, most employees don’t understand their increasingly complex prescription insurance.

If politicians want to get serious about controlling how voters feel about their prescription costs, they should focus on understanding the structure of commercial and Medicare Part D benefit designs.

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