Table 3. Annual Out-of-Pocket Spending per Beneficiary per Ultra-Expensive Drug by Subgroup, Intra-Insurer Comparisons, 2013-2019.
| Year | Measurementa | Part D, $ | Commercial insurance, $ | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Plan subgroup | Age subgroup | Plan subgroup | Age subgroup | |||||||||||
| MAPD | Stand-alone PDP | 65-69 y [Reference] | 70-74 y | ≥75 y | <65 y | HMO [Reference] | PPO | HDHP | 45-49 y [Reference] | 50-54 y | 55-59 y | 60-64 y | ||
| 2019 | Mean | 4301 | 4575 | 4496 | 4614 | 4257 | 5142b | 1208 | 1569c | 4077d | 1963 | 1865 | 1779 | 1735b |
| Median (IQR) | 4131 (3000-6048) | 4190 (3305-5799) | 3928 (2942-5844) | 4139 (3317-5721) | 3536 (2659-4895) | 4837 (3609-7107) | 752 (317-1240) | 838 (481-1472) | 2882 (1075-4226) | 1094 (433-1831) | 1226 (501-2053) | 1239 (586-1956) | 1142 (401-1801) | |
| 2018 | Mean | 4451 | 4838 | 4679 | 4805 | 4524 | 5257 | 1118 | 1274 | 3751d | 1674 | 1517 | 1532 | 1420c |
| Median (IQR) | 4055 (3263-5566) | 4419 (3697-6016) | 4123 (3077-5740) | 4214 (3140-5471) | 3905 (2888-4892) | 5409 (4082-7521) | 872 (431- 1367) | 738 (380-1378) | 3081 (1494-4124) | 966 (406-1493) | 1200 (625-1639) | 1174 (645-1619) | 830 (300-1549) | |
| 2017 | Mean | 4443 | 4679 | 4499 | 4703 | 4468 | 5115b | 921 | 1107b | 3266d | 1380 | 1259 | 1318 | 1217c |
| Median (IQR) | 4168 (3270-5225) | 4516 (3846-5869) | 4204 (3013-5005) | 4342 (3467-5514) | 4001 (3065-5091) | 5269 (4082-7491) | 727 (350-1122) | 843 (501-1169) | 2757 (1736-3727) | 837 (343-1406) | 943 (435-1392) | 958 (520-1609) | 980 (537-1362) | |
| 2016 | Mean | 4431 | 4484 | 4476 | 4518 | 4207 | 5235b | 742 | 1078d | 2661d | 1163 | 1162 | 1175 | 980b |
| Median (IQR) | 4127 (3425-5460) | 4515 (3804-5638) | 4543 (3651-5660) | 4238 (3612-5134) | 3871 (2978-5007) | 5004 (3943-7107) | 561 (310-853) | 840 (506-1236) | 2546 (1631-3583) | 964 (521-1325) | 1008 (481-1444) | 761 (432-1367) | 790 (476-1171) | |
| 2015 | Mean | 4546 | 4381 | 4555 | 4443 | 4039b | 5393c | 816 | 1062c | 2961d | 1098 | 1049 | 1053 | 925b |
| Median (IQR) | 4209 (3057-5979) | 4355 (3488-6227) | 4229 (3239-5198) | 4309 (3435-5009) | 4138 (3137-5181) | 5401 (3816-7059) | 377 (196-721) | 609 (431-901) | 2546 (1414-3363) | 748 (483-1362) | 606 (327-963) | 622 (357-1116) | 600 (353-811) | |
| 2014 | Mean | 4224 | 4036 | 4239 | 4205 | 3737 | 4818 | 546 | 805b | 2264d | 852 | 870 | 836 | 811 |
| Median (IQR) | 4097 (3259-5475) | 3887 (3315-5826) | 3987 (3165-5816) | 4009 (3365-4958) | 3654 (2789-4823) | 4440 (3685-5907) | 370 (180-608) | 676 (502-906) | 1985 (1015-2965) | 764 (479-1034) | 722 (466-1054) | 721 (525-929) | 680 (442-1084) | |
| 2013 | Mean | 4091 | 3779 | 3822 | 4150 | 3543 | 4589b | 507 | 857 | 2309c | 756 | 670 | 695 | 1034 |
| Median (IQR) | 4332 (3390-6204) | 3763 (3361-5208) | 3809 (3144-5811) | 3901 (2802-4568) | 3426 (2067-4097) | 4423 (3226-6404) | 286 (83-503) | 753 (502-1024) | 1981 (770-3246) | 640 (342-925) | 596 (352-876) | 595 (287-804) | 514 (365-893) | |
Abbreviations: HDHP, high-deductible health plan; HMO, health maintenance organization; MAPD, Medicare Advantage prescription drug plan; PDP, prescription drug plan; PPO, preferred provider organization.
a
Means are volume weighted based on claims per drug.
b
P < .05.
c
P < .01.
d
P < .001.