As employers seek ways to reduce health care costs, they are taking a harder look at high-deductible health plans (HDHPs) and also moving into four-tiered copayment structures.
According to a survey of nearly 3,000 employers by the Kaiser Family Foundation and Health Research and Educational Trust, the share of employers that offered an HDHP — at least $1,000 for single coverage and $2,000 for family coverage — quadrupled from 2003 to 2005.
This year also saw a 33 percent jump in the share of employers offering a four-tier drug benefit. Often, the fourth tier is reserved for higher-cost injectables and biologic treatments, but this movement is still young. Humana, for example, includes some specialty drugs in the fourth tier of its pharmacy benefit — one of several benefit designs its members can choose — but places others under the medical benefit.
Medco Health, which encourages use of preventive medications by HDHP enrollees, is testing a value-based program — placing drugs for high-risk conditions in the second tier, while drugs for lower-risk conditions go into higher tiers with higher copayments.
Average copayments for covered workers, 2003–2005
Average copayments were calculated by combining weighted average copayments among companies with a single copayment or a multitier cost-sharing structure. For fourth-tier drugs, data are based on plans that offer a fourth-tier copayment.
Some payers claim they can achieve savings as high as 25 percent by using a single specialty drug supplier or distributor and with increased utilization review.
But until more data are compiled to document savings from these various approaches, the impact of specialty drugs on employee health benefits has yet to play out.
Employer opinions on the effectiveness of cost-containment strategies
SOURCE: KAISER/HRET SURVEY OF EMPLOYER-SPONSORED HEALTH BENEFITS: 2000–2005