New Report from AIS Prescription Benefit Database Finds HMO Plan Type Increased 8.7% Over First Three Years of Exchanges

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A new report from the editors of Atlantic Information Services’ Rx Benefit Design Data offers comparative analysis of the drug benefits on exchange plans.

Atlantic Information Services, Inc. (AIS) is pleased to announce the release of a new report, Year-Over-Year Analysis of Prescription Drug Benefits of Health Plans: 2014-2016. Prepared by the editors of AIS’s online subscription database Rx Benefit Design Data, the report contains comprehensive charts and tables that can be used to compare every exchange plan on the market, including breakdowns of plans by metal level and plan type. The report also offers analysis of average medical deductibles, average copays and coinsurance by formulary tier for both retail and mail-order drugs, and average out-of-pocket limits for all exchange plans.

Findings from Year-Over-Year Analysis of Prescription Drug Benefits of Health Plans: 2014-2016 include:

  • Insurers on exchanges have steadily increased HMO (up 8.7% from 2014) and EPO (up 3.6% from 2014) offerings while offering fewer PPO products (down 9.1% from 2014).
  • Silver HMO plans comprised the greatest percentage of all plans in 2016, compared with all other metal level and plan type combinations. 48.1% of silver plans offered in 2016 were HMOs.
  • The average out-of-network annual overall deductible for an individual increased the most on the catastrophic level, from $10,675.93 in 2014 to $13,474.06 in 2016. Plans at the catastrophic level out of network also experienced the largest increase in out-of-pocket maximum, up 26.9% in 2016 from an average of $15,961.83 in 2014.
  • The average retail copay for in-network specialty drugs rose 57.1% from $62.30 in 2015 to $97.88 in 2016, mirroring the general trend of rising specialty drug costs from 2015 into 2016.

A free copy of the analysis may be downloaded from the RxB demo website in the site’s In-App Downloads section. For more information, and to access the demo, visit

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for nearly 30 years. It develops highly targeted news, data and strategic information for managers in hospitals and health systems, health insurance companies, medical group practices, purchasers of health insurance, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, databases, websites, looseleafs, strategic reports, directories, webinars and virtual conferences. Learn more at

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

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