Prescription drug cost-sharing easing for some

Does it feel as if your cost-sharing amount for prescription drugs has been soaring?  Maybe not, if your employer provides your drug insurance.

A new study by the Kaiser Family Foundation shows that, for workers and their families who have drug insurance through their employers, that prescription cost-sharing has actually gone down – from a recent high of $167 in 2009 to $144 in 2014. Most of the decline in out-of-pocket spending occurred between 2009 and 2012.  The Kaiser analysts think it’s likely due to people substituting generics for popular brand-name drugs that lost patent protection during that period of time. The decline in out-of-pocket-spending continued from 2012 to 2014, with nearly two-thirds of the decline during this period attributable to a requirement in the Affordable Care Act that most drug plans must cover the price of contraceptives without cost-sharing with the patient.

The other side of the drug cost coin is that the relatively small number of people spending more than $1,000 a year out-of-pocket on prescription drugs rose in the past decade, from 1 percent in 2004 to 2.8 percent in 2014.  The study finds that their spending accounted for a third of all out-of-pocket drug spending by enrollees in large-employer drug plans in 2014.

Other drug cost findings include:

  • Mirroring the national trend, average retail drug spending by employer plans spiked in 2014, rising 13 percent after growing relatively slowly for the previous nine years. Those plans absorbed much of the increase over the decade, spending an average $909 a year per person on prescription drugs in 2014, compared to $584 in 2004.
  • After the Affordable Care Act began requiring drug plans to make birth control available without cost sharing, the percentage of women of reproductive age with out-of-pocket spending for contraceptives fell sharply, from 22 percent in 2012 to 3.7 percent in 2014.
  • In an average month in 2014, about 0.5 percent — or approximately 375,000 people — covered by large-employer plans spent more than $250 on prescription drugs.

Prescription drugs are one of the leading contributors to overall health spending growth in the U.S. and insurers frequently cite these higher drug costs as a reason for raising premiums.


About the Author

Ed Tobias
Ed Tobias brings more than four decades of reporting and news management experience to his work at Rx411. Tobias managed news coverage for Associated Press Radio for over twenty years. This included coverage of the 9/11 attacks, the Iraq War, Hurricane Katrina, the death of Princess Diana, the Challenger and Columbia shuttle disasters and national election primaries, conventions and campaigns. He was part of the team that built AP’s on-line video operation. Prior to joining AP, Tobias was News Director at all-news WTOP in Washington, D.C.