Table 2.
Variable | Antidepressants | Antidiabetics | Statins |
---|---|---|---|
Cost-sharing for a generic drug ($) | |||
5th percentile | 0 | 0 | 0 |
25th percentile | 5 | 4 | 5 |
Mean | 6 | 5 | 6 |
Median | 7 | 7 | 7 |
75th percentile | 7 | 7 | 7 |
95th percentile | 9 | 8 | 9 |
Cost-sharing difference between brand and generic drugs ($) | |||
5th percentile | 16 | 16 | 16 |
25th percentile | 26 | 26 | 25 |
Mean | 32 | 31 | 28 |
Median | 31 | 31 | 31 |
75th percentile | 33 | 33 | 32 |
95th percentile | 64 | 49 | 37 |
Prior authorization (%) | 6.2 | 41.9 | 6.7 |
Step therapy (%) | 44.8 | 53.2 | 40.1 |
Deductible (%)† | 21.5 | 21.8 | 21.5 |
Gap coverage (%)‡ | 17.2 | 17.6 | 14.6 |
Premium per month ($) | |||
5th percentile | 24 | 24 | 24 |
25th percentile | 33 | 33 | 35 |
Mean | 43 | 43 | 42 |
Median | 38 | 38 | 38 |
75th percentile | 44 | 45 | 43 |
95th percentile | 81 | 81 | 78 |
Plan features are described at person level.
In Medicare Part D program, the deductible is a specific amount of money that beneficiaries have to pay for their prescriptions before their Part D plans start to pay their share of enrollees' prescription drug claims. The deductible varies across plans, some plans may have a deductible while others do not; besides, plans can have different amounts for their deductibles.
The Medicare Part D standard benefit design requires beneficiaries (except those with low-income-subsidies) to pay for 100% of total prescription costs after their expenditures exceed the initial coverage phase and before reaching the catastrophic coverage limit. This benefit phase is usually called "coverage gap" or "doughnut hole". However, plans can offer alternative benefit designs with gap coverage that covers some drug costs in the gap.