- The Pew Charitable Trusts last week released a study on the prescription drug coverage landscape in the United States. The top three findings were
- Net spending increased each year of the study period, from $250.7 billion in 2012 to $341.0 billion in 2016.
- Total health insurance premiums allocated to the pharmacy benefit of health plans increased from 12.8 percent in 2012 to 16.5 percent in 2016.
- Policies with capped out-of-pocket expenses and cost-sharing assistance from manufacturers helped shelter patients from rising drug costs throughout the study period.
FEHBP member cost sharing for prescription drugs is capped in accordance with the Affordable Care Act. FEHBP coverage for prescription drug skews much higher than 16.5% because the Program has a large cadre of Medicare prime annuitants. For those enrollees and spouses, Medicare pays for hospital care while the FEHBP pays for prescription drugs.
- Avik Roy posted a column in Forbes explaining why the specialty drugs are the principal driver of prescription drug spending – the ACA’s provision on bio-similar drugs is ineffective. Check it out.
- United Healthcare announced today that effective next year new employer plan sponsor customers for UHC and its Optum prescription benefit manager must accept a benefit design that pass along prescription drug rebates to plan members at the point of sale. This is an optional benefit design for employer plan sponsor customers this year. The UHC press release explains
Just two months into the year, the existing program has already lowered prescription drug costs for consumers by an average of $130 per eligible prescription. UnitedHealthcare data analytics demonstrate that when consumers do not have a deductible or large out-of-pocket cost, medication adherence improves by between 4 and 16 percent depending on plan design, contributing to better health and reducing total health care costs for clients and the health system overall.