Center for Studying Health System Change Examines the Growth of Tiered Prescription Drug Benefits

The Center for Studying Health System Change on Nov. 14 released an issue brief examining how health plans are increasingly using tiered systems to bring down spending on prescription drugs. Last year, prescription drug spending grew by 14.5%, more than double the overall increase in health spending that year. According to the brief, which was based on interviews with health plan officials in 12 "nationally representative communities," the move toward tier benefits -- in which consumers pay lower copayments for generic drugs and higher copayments for brand-name and non-preferred drugs -- has apparently helped to control drug spending, but "raises questions about the cost and quality of pharmaceutical care for consumers." Glen Mays, a health researcher at Mathematica Policy Research Inc. and lead author of the brief, said, "Prescription drug spending is one area where health plans are having some limited success in controlling costs, but health plan executives generally don't believe drug use and cost trends will slow much. If costs continue to escalate, the end result could be reduced pharmacy benefits that restrict consumer access to appropriate drug therapy -- especially for low-income and chronically ill people" (HSC release, 11/14). The full brief is available online.