Retail and mail copayments on the rise

Increases in both retail and mail copayments for generics, preferred brands, and nonpreferred brands are on the rise, with members paying a greater percentage of retail costs than of mail-service costs, according to the Pharmacy Benefit Management Institute’s Prescription Drug Benefit Cost and Plan Design Report.

The report captured copayment and coinsurance amounts for retail and mail prescriptions for generics, preferred brands, and nonpreferred brands. On average, members paid 26.6 percent of a retail prescription and 19 percent of a mail prescription.

In the past, employers created incentives for members to use mail service by keeping cost sharing low relative to retail cost sharing. Although mail-service discounts are higher, the lower cost sharing amounts that characterize mail prescription service often result in mail-service prescriptions costing employers more than retail prescriptions.

Employers learned that mail service will not produce savings unless cost sharing is structured appropriately. Average mail copayments for a 90-day supply are now slightly more than two times the average retail copayments for a 30 day supply of generics, preferred brands, and nonpreferred brand categories.

According to the report, average coinsurance for retail increased little, and mail coinsurance for generics and preferred brands actually declined slightly. Copayments rose at a greater rate than coinsurance.

Source for both graphs: Prescription Drug Benefit Cost and Plan Design Report 2008-2009 Edition

MANAGED CARE June 2009. ©MediMedia USA

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