In New Express Scripts Data: The Drug Spending Slowdown Is Real, I analyzed the latest drug trend report from pharmacy benefit manager (PBM) Express Scripts. To complement our earlier analysis, Express Scripts was kind enough to provide Drug Channels with an exclusive analysis showing the distribution of out-of-pocket costs for nearly 26 million people.
Despite consumer surveys complaining about “high drug prices,” the reality is that most people don’t pay much for their prescriptions. In 2017, about 95% of people with commercial insurance had less than $40 per month in out-of-pocket prescription costs. About half of them paid nothing, because they filled no prescriptions.
The remaining few percent had thousands of dollars in out-of-pocket obligations—though it’s not clear how much they actually paid.
Given these findings, plan sponsors—health plans and employers—should be cautious before blocking copayment support for the small number of patients taking specialty drugs. As Dr. Lucy Van Pelt says: Happiness is being able to afford necessary medication.
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