It’s time for our annual deep dive into employer-sponsored health coverage via the 2019 Kaiser Family Foundation Employer Health Benefits Survey. This report provides valuable national benchmarking data. You can read it online for free.
Below, you’ll find my highlights of the report’s findings on prescription coverage. I summarize employers’ 2019 pharmacy benefits by examining (1) cost sharing tier structures, (2) the prevalence of copayment vs. coinsurance, and (3) average copayments and coinsurance rates, by formulary tier. I break down the 2019 results for plans with and without high deductibles.
Employer benefit designs increasingly expose patients to the list price of their prescriptions. This is due largely to the benefit designs described below, which have shifted out-of-pocket spending for prescription drugs from copayments toward deductible and coinsurance spending. As you will see, cost sharing for prescription drugs in high-deductible plans differs significantly from that of plans that lack high deductibles. Plans with no limit on out-of-pocket expenses remain distressingly common.
Patients are finding their benefits to be increasingly mysterious, with more tiers, more coinsurance, and greater use of deductibles. When people complain about “drug prices,” they are actually complaining about the share of costs that they pay—and how those costs are computed. Put another way, the plan details won’t give employees a glad expression.
Read on for my analysis along with our annual Drug Channels tiers/tears puns.
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