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Lower Expenses, Fewer Rxs Follow Multitiered Drug Benefit Design

Medicare beneficiaries in health plans with a three-tiered drug benefit had lower drug expenses and filled fewer prescriptions than people in plans with no tiers after controlling for demographic factors, health status, and medical copayments according to a study published in Health Services Research. On average, beneficiaries in employer-?sponsored retiree health plans incurred $313 less in annual drug expenses and filled 6.7 fewer prescriptions than those in plans without tiers. This was a 14.3 percent and 14.6 percent reduction in drug cost and use, respectively. However, those in three-tiered plans had higher out-of-pocket expenses than those in plans with no tiers.

When the researchers looked specifically at expenses for long-term maintenance drugs to treat chronic conditions, they found that Medicare beneficiaries were less responsive to cost-sharing requirements and more likely to shift into generic substitutes, implying that “multitiered plans may curtail inefficient use, without necessarily curtailing utilization of drugs that have beneficial consequences,” says Boyd Gilman, senior researcher at Mathematica Policy Research.

“Multitiered copayment structures may be effective in controlling costs for the plan, but insurers have to be careful because they may also introduce barriers to care. Insurers need to be sensitive to whether or not you sacrifice access to important, necessary drugs for greater cost control,” says Gilman.

“Our results show that multitiered plans may induce more efficient use of drug resources without sacrificing access to essential medications,” adds John Kautter, coauthor and senior economist at RTI International, a research company. The study was based on drug claims before the implementation of the Medicare Part D outpatient drug program.

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