Managed Care - November 2008 - (Page 43)

THE FORMULARY FILES Use of multitier benefit designs increases Three tiers or four tiers are the drug benefit designs of choice among employers looking to rein in costs, according to findings presented in the Pharmacy Benefit Management Institute’s Pharmacy Benefit Cost and Plan Design Report. From 2007 to 2008, the percentage of employers who implemented a three-tier plan design with copayments rose from 45.3 percent to 60.5 percent. Overall, more than 75 percent of employers use plan designs with two or more tiers. Health plans can use the report “to see what types of drug benefit programs employers are implementing in terms of cost sharing and utilization manageCommon plan configurations Percentage of plans using configuration 70 60 50 40 30 20 10 0 Two-tier design with dollar copayments 16. 8 14. 8 7. 9 14. 4 4. 5 Three-tier design with dollar copayments Three-tier design with coinsurance 17. 9 11. 5 20. 2 4. 1 9. 4 2007 2008 45. 3 60. 5 ment,” says Dana H. Felthouse, MBA, PBMI president. “They can use the information in their product development. They can also look at utilization, average costs, and average rebates to see how their customers compare to national averages,” These designs have allowed employers to keep their rate of drug cost increases “to an average of 4.86 percent, the lowest rate since 1995,” says Felthouse. “This is a decline of 2 percent from last year’s survey.” The survey also shows increases in both retail and mail copayments for generic drugs, preferred brands, and nonpreferred brands. Two-tier design with coinsurance Four-tier design with dollar copayments Four-tier design with coinsurance Percentage change in flat dollar amount and percentage change in coinsurance, 2007–2008 12 10 8 6 4 2 0 –2 Generic Preferred brands Nonpreferred brands 6.0 9. 3 6. 6 7. 5 6. 1 3. 9 2. 5 0. 4 –0.5 Generic –0.5 Preferred brands Nonpreferred brands Copayment Coinsurance Retail Mail 3. 6 2. 4 Source: Pharmacy Benefit Management Institute. Prescription Drug Benefit Cost and Plan Design Report. 2008–2009 edition. NOVEMBER 2008 / MANAGED CARE 43

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.