Managed Care

Copayment, coinsurance rates change little

Copayments, rather than coinsurance, apply to the majority of workers covered by health plans that have three or more drug tiers, according to a recent Kaiser Family Foundation report. Percentages vary slightly across drug types, mostly because some plans have copayments for some drug tiers and coinsurance for others.

For members in plans with three or more tiers of cost sharing, average copayments in 2011 were consistent with the amounts reported in 2010, says the report. The 2011 averages were $10, $29, $49, and $91.

Coinsurance levels can be described in a similar way.

Members in plans with three, four, or more tiers of cost sharing for prescription drugs who pay coinsurance rather than copayments face coinsurance levels that average 18 percent for first-tier drugs, 25 percent for second-tier drugs, and 39 percent for third-tier drugs — similar to the percentages reported last year.

The report says 14 percent of covered workers are in a plan that has four or more tiers of cost sharing for prescription drugs. For covered workers in plans with four cost-sharing tiers, 36 percent face a copayment for fourth-tier drugs and 24 percent face coinsurance.

The average copayment for a fourth-tier drug is $91 and the average coinsurance is 29 percent. These amounts are not statistically different from the amounts reported in 2010.

Copayment, coinsurance amounts largely unchanged in plans with three or more tiers

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2001–2011

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