AIS Researchers Identify Trends in Design, Structure of Prescription Drug Benefits On and Off Insurance Exchanges

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AIS’s Rx Benefit Data has found changes in health plans’ drug benefit offerings between 2014 and 2015, identifying trends in plan design for this market — including increased copay amounts, more plans requiring a separate prescription deductible, and a greater prevalence of HMOs over PPOs.

The editors of Atlantic Information Services’ new subscription database AIS’s Rx Benefit Data (RxB) examined trends in the design and structure of integrated prescription drug benefits of qualified health plans offering products both on and off exchanges, and found several trends that plans may want to research further for maximum competitive advantage. Based on original AIS research into 19,049 commercial risk-based health plans, comparing 2014 to 2015, researchers found:

  • Prescription copay amounts generally increased in the second year, while prescription coinsurance percentages decreased.
  • Catastrophic and Platinum level plans had the biggest increases in out-of-pocket maximum for in-network benefits.
  • 14% of health plans in the individual/small group market require a separate prescription deductible — up from 2014.
  • PPOs dominated the marketplaces in 2014, but the HMO model took over in 2015.
  • Platinum plans were the only metal level to, on average, have a lower overall deductible in 2015 than in 2014.

The findings were analyzed and published in a 34-page data report available exclusively to RxB subscribers. RxB features two full years of searchable data — more than 19,000 health plans with complete details on their drug benefit parameters, including cost-sharing per formulary tier, per retail or mail-order, and for in-network and out-of-network benefits. The service also features original AIS news reporting on issues that may impact plans’ benefit design strategies. For more information and to use a fully interactive demo of RxB, visit https://aishealthdata.com/index.php?q=rxb.

About Atlantic Information Services
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.

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Susan Namovicz-Peat, Director, Directories and Databases Division
Atlantic Information Services
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