MANAGED CARE January 2013. ©MediMedia USA
The Formulary Files
13% of workers pay separate drug deductibles
About 99 percent of workers in plans sponsored by employers have a prescription benefit. And while the majority don’t have to pay a separate prescription deductible or have an annual out-of-pocket limit that applies only to prescription drugs, about 13 percent do, according to the 2012 Kaiser/Health Research & Educational Trust (HRET) Employer Health Benefits Survey.
A breakout by plan type shows that 17 percent of covered workers in PPOs had a separate drug deductible — higher than in HMO and POS plans in 2012. PPO plans also had the highest percentage of workers with separate out-of-pocket limits for prescription drugs (13 percent).
For workers in plans with a separate prescription deductible, nearly 70 percent report that the deductible was applied to every drug tier. The average deductible was $145.
About 11 percent of workers with coverage for prescription drugs are in plans with a separate prescription drug annual out-of-pocket limit: The average was $1,722 in 2012.
The survey found that in general, workers at companies with 35 percent or more workers earning no more than $24,000 a year are more likely to face high deductibles than those at higher-wage companies. Specifically, 44 percent of covered workers at businesses with many low-wage workers face an annual deductible of $1,000 or more, compared with 29 percent of those at employers with many high-wage workers. Across all employers, 34 percent of covered workers face a deductible of that size, including 14 percent with deductibles of at least $2,000 annually.
The Kaiser/HRET annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing, and other relevant information. The 2012 survey included 3,326 randomly selected public and private businesses with three or more employees.
Workers have drug coverage and a separate prescription drug deductible
Workers have drug coverage and a separate annual out-of-pocket limit for prescription drugs
Source for both: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2005–2012