TABLE 5.

Mean Out-of-pocket Expenses for Covered and Non-covered Drugs in the “Market Basket” of Drug Claims^†

	Average Out-of-Pocket Spending ($)
Plan	All Drugs	Covered Drugs	Uncovered Drugs
Part D Plans
A	995	994	1
B	1,020	1019	1
C	1,047	1,046	1
D	1,064	1063	1
E	1,176	895	281
F	1,324	869	455
G	1,376	832	544
H	1,452	909	543
I	1,458	840	618
J	1,943	753	1,190
Non-Part D Plans
Medi-Cal	38	38	0
TRICARE	454	252	202
CALPERS	755	747	8
Blue Cross	769	769	0
FEP	846	846	0
VA‡	1,348	188	1,160
Kaiser	2,006	276	1,730

Sources: Authors calculations based on formulary restrictions and benefit designs of 10 major Part-D plans and 7 non-Part D plans. Because the 300 most common drugs sometimes included branded and generic versions of the same drug, the calculated expenditure in the VA plan treats branded drugs as covered if a generic equivalent is covered.

^†For drugs that were not covered by the plan ─ either because they were excluded from the formulary or because the beneficiary’s cumulative spending was below the deductible or in the doughnut hole ─ we assigned an out-of-pocket payment equal to the full price of the drug (excluding rebates). We used the full price of the drug for each Part D plan as reported on the Medicare website in July 2007.

^‡Our “market basket” of drug claims includes multi-source brands (brand drugs with generic equivalents) that may not be covered under the VA formulary. We assumed that patients in the VA received the generic equivalent and paid an $8 copayment.