What Health Crisis? The Co-Pay Fell Last Year
8 CommentsBy Ed Silverman // April 17th, 2008 // 1:24 pm
Although the headlines say many people are paying more for their meds, one pharmacy benefits manager argues last year marked the first time in five years that consumers paid, on average, a lower co-pay. To be specific, the average copay dropped 25 cents to $13.20 even as the average total cost of a scrip rose from $55.01 to $55.93, according to a report issued by Express Scripts, which manages 55 million patients.
The PBM attributes the decrease to greater use of generics, which it claims saved consumers an average of $15 per scrip each time they moved from a brand to a generic. Of course, PBMs do make more money on generics, so it may not come as a surprise that Emily Cox, Express Scripts’ senior director of research, says 67 percent of the million scrips that the PBM procceses every day are for generics, up from 42 percent in 2002.
Express Scripts goes on to say that consumers paid a smaller share of the total cost last year as their share decreased from 24.5 percent to 23.6 percent. But plan sponsors still gained because greater use of generics resulted in the smallest recorded year-to-year increase in the total cost of an average scrip – at 1.6 percent compared with 2.2 percent in 2006, and 2.8 percent in 2005.
Between 2002 and 2007, the average co-pays for preferred and non-preferred brand drugs increased more rapidly than the generic copay, which increased by 86 cents from $6.71 to $7.57. By comparison, the PBM says the preferred brand co-pay increased $4.52 from $14.66 to $19.18, and the non-preferred co-pay increased $11.28 from $17.16 to $28.44.
Meanwhile, specialty drugs cost an average of $1,550.28 per scrip last year, and the consumer share remained constant at 2.6 percent in 2006 and 2007. Because the average cost of a specialty scrip increased 7.8 percent year over year, the average co-pay increased $3.01 from $38.33 to $41.07. You can read more here about the extent of the problem.
Atlex
I wonder if Express Scripts read the entire aticle. The main point wasn’t only that overall co-payments are rising, but that for those on high cost specialty drugs, the co-poays have become astronomical. Muchof the focus was on the Medicare Part D program, where Express Scripts is a very minor player.
Lisa Van S
Atlex,
Im a bit confused on this issue, are co-pays lower through Medicare PartD then regular insurance. My Brother is disabled due to MS (He’s 42). and rcves Medicare benefits.
HorusCat
Lisa,
The copay each Medicare Part D person pays depends on which plan they have. Some plans cost more but provide more access to non-generic drugs. Most Part D plans, though, have pretty high co-pays for the biologics, I believe.
HC
Bob Freeman
HorusCat and Lisa: yes, there is a lot of variability in benefit design for Part D plans. It’s a nightmare at times for patients, pharmacists and physicians. One insurer can offer multiple Part D products in the same service area.
Lisa, if your brother is a dual-eligible, he can change plans on a monthly basis as opposed to others who are locked in a plan for a year. However, his out-of-pocket costs should be subsidized. It’s worth going to the Medicare web site and using their software to compare plans.
HorusCat
Lisa,
Depending on which biologic he uses, the company should have a support service that will help him find the best plan for him.
HorusCat
Lisa,
BTW, that psych in Kansas who works for Pfizer–I think he’s gone. Checked it out on the Pfizer board on CP and it looks like he got hands-on with a couple of reps.
Atlex
Lisa, HorusCat is essentially correct. It sounds as though your brother-in-law is dually eligible and thus pays branded drug co-pays of ~$3.15. However, for most Part D enrollees the co-pays are typically greater than in commercial plans. Moreover, in the majority of plans, the high cost drugs are on tier 4 where co-pays range from 25% to 33% until catastrophic coverage kicks in and the co-pay drops to 5%. A non-dual (or low income) enrollee on a $10K per year drug might pay $3K or more for his/her drug. An enrollee on a $100K a year drug would likely pay <$10K.
If you have specific Part D questions, you know how to reach me.
Lisa Van S
Thanks Guys,
He was getting injections, now he takes pills. I know that the local MS Foundation has provided his wife with information.