Now that 2023 is underway, let’s review employer-sponsored coverage for prescription drugs and speculate on what’s ahead.
Below I examine the latest data on pharmacy benefits: cost sharing tier structures, copayment vs. coinsurance, and out-of-pocket obligations. As you will see, pharmacy benefit designs again increased the use of coinsurance for specialty and fourth-tier drugs.
These designs significantly raise patients’ out-of-pocket obligations—and contribute to the controversy over copay accumulator adjustment and copay maximizers. In 2023, employers’ savings and PBMs’ profits from these programs will decline—which will trigger a coming crackdown on specialty drug benefits. Beneficiary beware!
P.S. As usual, you will also enjoy some terrible Drug Channels tiers/tears puns.
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