Friends with (Pharmacy) Benefits

  • by: |
  • 01/26/2016

A new report by the Pharmacy Benefit Management Institute (PBMI) makes some very interesting points about the value of PBMs to employers and employees. Some highlights include:

* PBM generic copays are in line with overall inflation, only increasing from $9.85 to $10.85 over a 15-year period in inflation-adjusted dollars.

* Preferred and non-preferred brand copays (preferred brand from $19.43 to $31.08 and non-preferred from $37.58 to $56.65) have outpaced inflation considerably.

* Plan sponsors increased use of prescription drug benefit deductibles by 157% in 2015 compared to 2014.

* In 2014, only 14% of plan sponsors reported having a deductible for prescription drugs compared to 36% in 2015.

* There is considerable opportunity for employers who are willing to implement additional strategies to control costs and utilization without shifting additional costs to members.

* Mail order in particular can save members an average of over four monthly copayments per prescription per year (annualized). For a member taking a preferred brand in a three-tier plan design, this equates to yearly savings of $138.88 for a single maintenance medication.

The complete report (sponsored by Takeda Pharmaceuticals) can be found here.


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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