SOURCE: Pharmacy Benefit Management Institute (PBMI)

Pharmacy Benefit Management Institute (PBMI)

December 16, 2014 11:39 ET

PBMI Research Shows Plan Sponsors Balance Cost Containment With Employee Drug Benefit Needs

PBMI Releases 2014-2015 Prescription Drug Benefit Cost and Plan Design Report

PLANO, TX--(Marketwired - Dec 16, 2014) -  Health care reform continues to add complexities to the pharmacy management landscape. However, plan sponsors are able to respond to the ebb and flow of the dynamics of the marketplace. According to Pharmacy Benefit Management Institute (PBMI) researchers, plan sponsors are finding ways to balance implementation of cost containment programs while meeting the drug benefit needs of their employees using focused strategies. The 2014-2015 Prescription Drug Benefit Cost and Plan Design Report was released today and includes responses from 353 employers representing more than 29 million lives.

"We are delighted to bring to the market for the 14th consecutive year our benefit design research report that captures marketplace trends specific to pharmacy management," said Jane Lutz, PBMI Executive Director. "Many of the findings in this year's report reflect a drug benefit that has become increasingly complex over time with the addition of copayment tiers, more choices for filling maintenance medications, and the movement to more narrow retail networks."

Key findings from the report include:

  • Cost-sharing continues to become more complex as many employers expand existing three tier plans to include specialty medications on a fourth tier in their copayment designs since last year.
  • Along with the steady increase of a retail 90 benefit by employers, the proportion of employers requiring enrollees to fill these prescriptions in a limited network of pharmacies is increasing.
  • While various types of value-based pharmacy benefit design tools have been widely publicized over the past five to 10 years, the use of these tools continues to decline, with 53% of respondents reporting using none of the tools listed in the survey (up from 43% in 2011).
  • Findings continue to point to familiar cost containment and quality improvement opportunities including step therapy, prior authorization, tools to facilitate prescribing interventions and programs to prevent medication fraud, waste, and abuse.

To request a printed copy or download a copy of this report click here.

About PBMI

The Pharmacy Benefit Management Institute provides research, continuing education, and Web resources that help health care benefit executives work effectively with their pharmacy benefit managers to improve the design and management of drug benefit programs. Learn more at  

Contact Information