PBMI Research Shows Drug Benefit Design Approaches Consistent With 2012

PLANO, TX--(Marketwired - Dec 10, 2013) - Uncertainty about the anticipated effects of health care reform is suggested by the results of the 2013-2014 Prescription Drug Benefit Cost and Plan Design Report released today, according to researchers at the Pharmacy Benefit Management Institute (PBMI), who found little change in drug benefit programs compared with last year. Employers may be waiting for the ground to settle before making any significant modifications to key benefit design features, such as cost-sharing, prior authorization, and rebate arrangements, the report explains. PBMI's annual benefit design survey, conducted earlier this year, includes responses from 478 employers representing 22.5 million members. The report provides benefit managers with information needed to make decisions about pharmacy benefit design programs.

"We are pleased to provide a comprehensive picture of the pharmacy benefit management marketplace again this year," said Brenda Motheral, PBMI Executive Director. "The report, which we've updated with a new look and feel to provide even more useful information for our readers, is unique in its focus on the experiences of plan sponsors including quantitative information about pharmacy discount rates and rebates." Key takeaway findings include the following:

• Copayment structures continue to dominate the marketplace but are used by about two-thirds of employers today, compared with 86% in 2008. Coinsurance systems, used by about one-third of employers, are steadily gaining traction.
• Four-tier structures were used by only about 8% of employers in 2008 but by about one-quarter of employers beginning in 2011.
• Use of copay reductions as a value-based incentive to drive member behavior has declined from 36% in 2011 to 22% in 2013, whereas tying rewards to participation in health risk assessments is on the upswing.
• Retail pharmacy initiatives, such as discount programs and 90-day community pharmacy dispensing, mean that narrow networks, currently used by 29% of employers, could become increasingly valuable as an alternative to mandatory/incentivized mail order.

Online and print copies of the report may be requested at www.pbmi.com.

About PBMI

The Pharmacy Benefit Management Institute provides research, continuing education, and Web resources that help health care benefit executives work effectively with their pharmacy benefit managers to improve the design and management of drug benefit programs. Learn more at www.pbmi.com.