SOURCE: Pharmacy Benefit Management Institute

Pharmacy Benefit Management Institute

December 19, 2012 11:12 ET

PBMI Survey Finds Retail Copays Are Increasing Across All Drug Types

Specialty Copays up 26%; Generic and Brand Copays up 10% to 13%

PLANO, TX--(Marketwire - Dec 19, 2012) -  Retail copays are on the rise again across all drug types, including generics, brands and specialty drugs. This is just one of the reported results from the 2012-2013 Prescription Drug Benefit Cost and Plan Design Report published by the Pharmacy Benefit Management Institute (PBMI). 

"Readers of this report can expect to see all of the survey results broken out by larger and smaller employers, a new change for this year," said Brenda Motheral, PhD, Executive Director of PBMI. "This report is the only industry report that captures data provided by plan sponsors about their pharmacy discount rates; and this year, we had a record number of plan sponsors sharing details about their pharmacy reimbursement and rebate amounts."

The 2012 survey was completed by 424 U.S. employers representing an estimated 3.7 million members.

Key survey results include:

  • Retail copays increased 10% for generics, 13% for brands, and 26% for specialty medications
  • An increased use of multi-tier designs, which now represent 92% of plan sponsors
  • The copay differential gap between tiers continued to grow
    • Average differential between generic and preferred brand copays is $19 compared to just $7 in 2007
    • Average differential between preferred and nonpreferred copays is $23 compared to $13 in 2007
  • A dramatic increase of employers are using step therapy as a management tool
    • Up to 65% from 56% in 2011
  • Use of retrospective drug utilization review is declining
  • Minimal adoption of medication therapy management for commercial populations
  • More active management of the pharmacy benefit among larger employers than smaller employers across virtually every aspect of the benefit. For example:
    • 74% of larger employers and 56% of smaller employers have implemented one or more step therapy program(s)
    • 89% of larger employers, compared to 73% of smaller employers are using quantity limits

Requests for online and print copies of the report are available via www.pbmi.com.

About the Pharmacy Benefit Management Institute

The Pharmacy Benefit Management Institute provides research and continuing education to help health care benefit executives work effectively with pharmacy benefit managers to improve the design and management of drug benefit programs.

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