Pharmacy benefit design options available to employers

Author: Encinosa, William E

Source: Expert Review of Pharmacoeconomics and Outcomes Research, Volume 2, Number 4, August 2002 , pp. 389-396(8)

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Abstract:

I explore all the pharmacy benefit options currently available to employers. First, I discuss the design of the benefit structure, which can involve up to five tiers of drug options and three tiers of pharmacy options. Next, I discuss how the employer can overlay a cost-sharing structure on top of that benefit structure, in order to provide each employee with the right balance of choice and incentives. The cost-sharing structure can entail up to seven main types of cost-sharing: copayments, coinsurance, incentive pricing, benefit caps, quantity caps, deductibles and defined contributions.

Keywords: drug costs; drug plans; pharmacy benefit design; prescription drug copayments; reference pricing

Document Type: Research article

DOI: http://dx.doi.org/10.1586/14737167.2.4.389

Publication date: 2002-08-01

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Expert Review of Pharmacoeconomics & Outcomes Research provides expert commentary on cost-benefit and pharmacoeconomic issues relating to the clinical use of drugs and therapeutic approaches. Coverage includes pharmacoeconomics and quality-of-life research, therapeutic outcomes, evidence-based medicine and cost-benefit research.
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