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HIRC Research Alert: Health Plans Expected to Increase Adoption of Percent Copays to Manage Specialty Medications
Date:6/3/2010

Health Industries Research Companies (HIRC) Specialty Pharmaceuticals Service is an ongoing market research study that provides detailed analyses on health plans’ coverage and management of specialty pharmaceuticals.

(PRWEB) June 3, 2010 -- Health Industries Research Companies (HIRC) Specialty Pharmaceuticals Service is an ongoing market research study that provides detailed analyses on health plans’ coverage and management of specialty pharmaceuticals.

Adoption of percent copays for specialty medications is forecast to grow in 2011.
HIRC asked health plan executives to assess the percentage of their commercial lives covered by three types of copays — fixed, percent and no copay —for specific medications in eight specialty drug classes. While the majority of patients remain covered by fixed copays (for medications administered in the pharmacy benefit), HIRC research finds that the usage of percent copays is expected to grow to an average of 38% in 2011. This uptake is due to “growth in the price and usage of specialty medications, the overall rising cost of health care, and the poor economy,” explains Karen Lucas, Director, Specialty Pharmaceuticals Service. Ms. Lucas further comments that “the growth of percent copays, specialty tiers, and wider copay differentials will be slow and steady as many employers remain reluctant to place heavy copay burdens on their employees.”

The majority of commercial health plan members are not covered by out-of-pocket limits.
Health plan panelists were asked to indicate if their plan has out-of-pocket limits in place to cover specialty medications. The number of plans offering out-of-pocket limits in the pharmacy benefit has remained at approximately 45% of plans since 2008. Additionally, many of the plans in HIRC research that offer out-of-pocket limits also report including other pharmacy
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