Table 2. Annual Out-of-Pocket Spending per Beneficiary per Ultra-Expensive Drug by Subgroup, Interinsurer Comparisons, 2013-2019.
| Year | Measurementa | Overall, $ | Age subgroups, $ | Plan subgroups, $b | |||||
|---|---|---|---|---|---|---|---|---|---|
| Commercial insurance | Part D | Commercial insurance, 60-64 y | Part D, 65-69 y | Commercial insurance, HMO | Part D, MAPD | Commercial insurance, PPO | Part D, stand-alone PDP | ||
| 2019 | Mean | 1821 | 4478c | 1735 | 4496c | 1208 | 4301c | 1569 | 4575c |
| Median (IQR) | 1272 (703-1924) | 4169 (3369-5947) | NA | NA | NA | NA | NA | NA | |
| 2018 | Mean | 1522 | 4703c | 1420 | 4679c | 1118 | 4451c | 1274 | 4838c |
| Median (IQR) | 1116 (615-1633) | 4437 (3579-5605) | NA | NA | NA | NA | NA | NA | |
| 2017 | Mean | 1283 | 4600c | 1217 | 4499c | 921 | 4443c | 1107 | 4679c |
| Median (IQR) | 1056 (663-1523) | 4344 (3856-5769) | NA | NA | NA | NA | NA | NA | |
| 2016 | Mean | 1105 | 4463c | 980 | 4476c | 742 | 4431c | 1078 | 4484c |
| Median (IQR) | 1001 (581-1356) | 4511 (3800-5639) | NA | NA | NA | NA | NA | NA | |
| 2015 | Mean | 1071 | 4430c | 925 | 4555c | 816 | 4546c | 1062 | 4381c |
| Median (IQR) | 743 (529-1028) | 4507 (3477-6119) | NA | NA | NA | NA | NA | NA | |
| 2014 | Mean | 896 | 4094c | 811 | 4239c | 546 | 4224c | 805 | 4036c |
| Median (IQR) | 820 (634-1187) | 4015 (3448-5751) | NA | NA | NA | NA | NA | NA | |
| 2013 | Mean | 836 | 3861c | 1034 | 3822d | 507 | 4091c | 857 | 3779c |
| Median (IQR) | 789 (563-1088) | 3893 (3473-5613) | NA | NA | NA | NA | NA | NA | |
Abbreviation: HMO, health maintenance organization; MAPD, Medicare Advantage prescription drug plan; NA, not applicable; PDP, prescription drug plan; PPO, preferred provider organization.
a
Means are volume weighted based on the number of claims per drug.
b
For subgroup comparisons, MAPD is compared with HMO and PDP is compared with PPO.
c
P < .001.
d
P < .05.