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

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.

UP NEXT

Managed Care
By Peter Wehrwein
Managed Care
By Howard Wolinsky