KANSAS CITY, Kan. – An analysis of prescription drug co-payments over the last three years shows that consumers in New England are paying more out of their own pockets for brand-name drugs regardless of the type of health plan they’re in, but co-payments for generic drugs have fluctuated.
The new report, “Compensation Data 2007 – New England,” is based on an analysis by Compdata Surveys of Kansas City, which looked at data from 2005 to 2007 for 160 organizations in Connecticut, Massachusetts, New Hampshire and Rhode Island with total employment of more than 165,000. The study examined pay and benefits data, as well as pay practices as of March 1.
Insurers have formularies that put drugs in different categories depending on their cost, known efficacy, and the availability of generic or over-the-counter alternatives. Generally, health plans include two or more co-pay tiers, with the lowest co-payment for a generic drug, a mid-range co-payment for a preferred drug in its category, and a higher co-payment for a non-preferred drug; some drugs may not be covered at all, especially if there over-the-counter alternatives are available.
The Compdata study found that the co-payments for non-formulary drugs (brands that are not preferred by the insurer) have risen by 12.1 percent to an average of $41.07 for preferred-provider-organization (PPO) plans, the most common in Rhode Island. Point-of-service (POS) plans, which are somewhat more restrictive than PPOs, have boosted non-formulary co-payments even more, by 17 percent since 2005 to an average of $41.29.
The cost of formulary drugs has also increased across the board, Compdata reported, to $25 for PPO plans – a 14.5-percent hike.
Co-payments for generic drugs, meanwhile, have fluctuated between $8.50 and $11.25 since 2005, the analysis found. PPO plans have an average co-payment of $10.30 for generic drugs, and POS plans are at $11.24.
“Despite reductions in health care coverage, the results have shown employers are still offering prescription plans as part of their health insurance,” said Amy Kaminski, manager of marketing programs for Compdata Surveys, in a news release. “In 2007, 99 percent of organizations reported offering prescription coverage with their PPO plans. And at least 97 percent of companies offering indemnity, HMO and POS plans provide prescription drug coverage.”
Compdata Surveys is a provider of compensation and benefits survey data. For additional information about Compdata or its “Compensation Data 2007 – New England” study report, go to www.compdatasurveys.com.
