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

copays (e.g. oral prescription agents) within the limit. Ms. Lucas expects that “plans will continue to put out-of-pocket limits in place as plan sponsors increasingly adopt percent copays.” Notably, in spring 2010 only one-third of commercial lives represented in HIRC research are covered by out-of-pocket limits.

The Patient Copays chapter of the Specialty Pharmaceuticals Service provides insight into health plans commercial fixed and percent copay enrollment and pricing, as well as out-of-pocket limits for eight key specialty categories.

Research Methodology:
Research was conducted in January and February 2010, with 52 pharmacy and medical directors at leading health plans representing over 46 million commercial lives. Follow-up interviews were conducted with a subset of panelists. In addition to the patient copay and pricing information highlighted in this update, the following updates are included in the Specialty Pharmaceuticals Service: location of benefits coverage, formulary and utilization management trends, and physician reimbursement and specialty pharmacy provider usage.

HEALTH INDUSTRIES RESEARCH COMPANIES (HIRC) is an independent, nonpartisan organization that conducts strategic market research on trends in health care, pharmaceutical, and managed care businesses. HIRC’s benchmark studies focus on the marketing needs of pharmaceutical companies by providing research critical to the development of successful customer-focused marketing strategies.

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