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. Author manuscript; available in PMC: 2015 Jun 1.
Published in final edited form as: Med Care. 2014 Jun;52(6):541–548. doi: 10.1097/MLR.0000000000000142

Table 2.

Plan features for the study sample*

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.