Managed Care


Copayments dominate drug cost sharing choices

MANAGED CARE November 2012. © MediMedia USA
The Formulary Files

Copayments dominate drug cost sharing choices

Workers covered by health plans with three or more prescription drug tiers are more likely to have copayments than coinsurance, according to the Kaiser Family Foundation’s “Employer Health Benefits 2012 Annual Survey.”

The survey says the average copayment amounts for 2012 in plans with three, four, or more tiers of cost sharing are comparable to 2011. For 2012, the average copayment for tier 1 was $10; tier 2, $29; tier 3, $51; and tier 4, $79. In 2011, copayments were $10, $29, $49, and $91, respectively.

Copayments are also more common than coinsurance for workers in plans with just two tiers. The survey reports in such plans, that the average tier 1 copayment is $11 and the average tier 2 copayment is $29. The average coinsurance rate for tier 2 is 27 percent. On the coinsurance side, employees in plans with three, four, or more tiers faced average coinsurance levels of about 20 percent for tier 1, 26 percent for tier 2, and 39 percent for tier 3.

The report notes that all the levels are similar to last year except for the average coinsurance for tier 1 drugs (20 percent), which is statistically different from 2011 (18 percent).

The foundation says that 14 percent of covered workers are in a plan that has four or more tiers. For covered workers in plans with three or more tiers, 55 percent face a copayment for tier 4 drugs and 36 percent face coinsurance.

The report lists the average copayment for a tier 4 drug as $79 and the average coinsurance for a tier 4 drug as 32 percent — not statistically different from 2011.

Average copayments and average coinsurance by drug type, 2000–2012

Source: Employer Health Benefits 2012 Annual Survey. Kaiser Family Foundation


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