Table 1.
Sample Statistics (N=1,074)
| Variable | Mean | SD |
|---|---|---|
| Prescription drug utilization measures* | ||
| Number of generic rxs PMPQ | 1.816 | 1.105 |
| Number of brand rxs PMPQ | 1.719 | 1.010 |
| Generic dispensing rate (GDR) | 0.518 | 0.060 |
| Number of retail rxs PMPQ | 2.204 | 1.525 |
| Number of mail rxs PMPQ | 1.331 | 1.261 |
| Mail distribution date (MDR) | 0.348 | 0.201 |
| Plan sponsor characteristics | ||
| Ages 0–11 | 0.148 | 0.054 |
| Ages 12–18 | 0.108 | 0.036 |
| Ages 19–39 | 0.271 | 0.094 |
| Ages 40–64 | 0.377 | 0.097 |
| Age 65+ | 0.083 | 0.144 |
| Male | 0.492 | 0.073 |
| West region | 0.116 | 0.243 |
| Northeast region | 0.132 | 0.252 |
| South region | 0.322 | 0.349 |
| Midwest region | 0.326 | 0.364 |
| Other region | 0.104 | 0.246 |
| Health plan (versus employer) | 0.068 | 0.252 |
| Three-tier plan (versus two-tier) | 0.686 | 0.464 |
| Two-tier member cost sharing† | ||
| Retail coinsurance | 0.495 | 0.463 |
| Retail generic OOP cost ($) | 7.25 | 3.45 |
| Retail brand OOP cost ($) | 23.33 | 10.86 |
| Mail–retail generic OOP cost ratio | 2.095 | 1.051 |
| Mail–retail brand OOP cost ratio | 1.775 | 0.871 |
| Three-tier member cost sharing‡ | ||
| Retail coinsurance | 0.202 | 0.373 |
| Retail generic OOP cost ($) | 8.79 | 3.67 |
| Retail P brand OOP cost ($) | 22.78 | 7.11 |
| Retail NP brand OOP cost ($) | 36.75 | 12.04 |
| Mail–retail generic OOP cost ratio | 2.115 | 1.346 |
| Mail–retail P brand OOP cost ratio | 1.827 | 0.488 |
| Mail–retail NP brand OOP cost ratio | 1.846 | 0.584 |
| Other pharmacy benefit design elements | ||
| Retail deductible | 0.109 | 0.288 |
| Retail dispense as written penalty (physician) | 0.224 | 0.398 |
| Retail dispense as written penalty (patient) | 0.326 | 0.440 |
| Retail maximum allowable benefit | 0.099 | 0.284 |
| Retail maximum out-of-pocket | 0.056 | 0.215 |
| Mandatory mail | 0.168 | 0.359 |
Note: All means and standard deviation values are expressed as proportions unless otherwise indicated.
*
Prescription drug utilization measures calculated using 30-day supply equivalents (i.e., 1 mail rx=3 retail rxs).
†
Presented are member cost-sharing means and standard deviations specific to two-tier plans.
‡
Presented are member cost-sharing means and standard deviations specific to three-tier plans.
NP brand, nonpreferred brand; OOP, out-of-pocket; P brand, preferred brand; PMPQ, per member per quarter; SD, standard deviation.