Tiered Pharmacy Benefit Plans on the Rise

In an effort to cope with soaring healthcare costs, more employers are establishing three-tier prescription drug benefit plans for workers. This year, almost 60 percent of workers with health insurance have pharmacy coverage that sets higher cost-sharing formulas for non-preferred medicines, compared with preferred products or generics. That figure is up considerably from the 36 percent of three-tiered plans in 2001 and is double the 29 percent rate in 2000. (See "More Workers Pay More.") The cost of pharmaceuticals within these tiers is also higher: brand-name therapies for which generic substitutes are available now cost consumers an average $26 co-pay per prescription, up from $20 in 2001, according to an annual survey of employer benefit plans conducted by the Kaiser Family Foundation (KFF) and the Health Research and Educational Trust (HRET). A total of 85 percent of workers now are in either two- or three-tiered plans, as more employers take steps to keep prescription drug costs under control.

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