Prescription Drug Cost Sharing

SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015 (including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

Share of Plans by Type of Cost Sharing for Generic Prescriptions Plans with Combined Medical and Prescription Drug Deductible

5% 1%

21%

46% 48%

38% 28% 25%

34%

12% 18%

22% 28%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Bronze Silver Gold Platinum

Copayment & Coinsurance

Coinsurance

Copayment

No Charge after Deductible

http://healthcare.gov/

https://www.healthcare.gov/health-plan-information/






Share of Plans by Type of Cost Sharing for Generic Prescriptions Plans with Separate Medical and Prescription Drug Deductible

17% 20%

2%

98%

82% 78%

97%

2% 1% 1% 1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Coinsurance

Copayment

No Charge








Average Copayment for Generic Drugs

$19

$13

$10

$8

$0

$2

$4

$6

$8

$10

$12

$14

$16

$18

$20









Distribution of Copayment Amounts for Generic Drugs

5% 11%

15%

33%

11%

34%

55%

67%

22%

37%

24%

1%

26%

15%

6%

25%

3% 0%

11%

1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Over $25

>$20 - $25

>$15 - $20

>$10 - $15

>$5 = $10

$5 or less








Average Coinsurance Rates for Generic Drugs

30% 29%

23%

26%

0%

5%

10%

15%

20%

25%

30%

35%









Distribution of Coinsurance Rates for Generic Drugs

13% 17%

38%

20%

19%

34%

20%

10%

37%

20%

23%

50%

7% 4%

5% 0%

24% 25%

15% 20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


40% or more

>30% - >50%

>20% - 30%

>10% - 20%

10% or less








Share of Plans by Type of Cost Sharing for Preferred Prescriptions Plans with Combined Medical and Prescription Drug Deductible

36%

17%

8%

26% 58%

69% 91%

38%

26% 23%

9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Coinsurance

Copayment









Share of Plans by Type of Cost Sharing for Preferred Prescriptions Plans with Separate Medical and Prescription Drug Deductible

81%

94% 93% 99%

19%

6% 7% 1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Coinsurance

Copayment








Average Copayment for Preferred Drugs

$63

$47

$37

$28

$-

$10

$20

$30

$40

$50

$60

$70









Distribution of Copayment Amounts for Preferred Drugs

7%

25%

2% 5%

27%

57%

6%

24%

48%

13%

47%

58%

13%

4%

6%

9% 4%

39%

3% 2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Over $60

>$50 - $60

>$40 - $50

>$30 - $40

>$20 - $30

20% or less








Average Coinsurance Rates for Preferred Drugs

32%

30%

27% 27%

24%

25%

26%

27%

28%

29%

30%

31%

32%

33%









Distribution of Coinsurance Rates for Preferred Drugs

2% 10%

17% 18%

24%

19% 12%

36% 39%

52%

64%

11%

11%

8% 27% 22%

11% 18%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


40% or more

>30% - >40%

>20% - 30%

>10% - 20%

10% or less








Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions Plans with Combined Medical and Prescription Drug Deductible

36%

20%

8%

20%

40%

52%

88%

44% 40% 40%

11%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Coinsurance

Copayment









Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions Plans with Separate Medical and Prescription Drug Deductible

56%

75% 78%

69%

44%

25% 22%

31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Coinsurance

Copayment








Average Copayment for Non-Preferred Drugs

$106

$85

$74

$55

$0

$20

$40

$60

$80

$100

$120









Distribution of Copayment Amounts for Non-Preferred Drugs

1% 4% 8%

60%

34%

47%

66%

35%

30%

39%

22%

4%

27%

9% 2% 8%

1% 2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Over $150

>$100 - $150

>$75 - $100

>$50 - $75

$50 or less








Average Coinsurance Rates for Non-Preferred Drugs

37% 37%

34%

33%

31%

32%

33%

34%

35%

36%

37%

38%









Distribution of Coinsurance Rates for Non-Preferred Drugs

2% 6%

13%

3%

17%

22%

19%

10%

29% 15% 10%

16%

51% 56% 58%

71%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


>30% - <50%

>20% - 30%

>10% - 20%

10% or less








Share of Plans by Type of Cost Sharing for Specialty Prescriptions Plans with Combined Medical and Prescription Drug Deductible

36%

22%

10%

1%

3%

9%

8%

1%

61% 68%

82%

98%

1% 1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Copayment and Coinsurance

Coinsurance

Copayment









Share of Plans by Type of Cost Sharing for Specialty Prescriptions Plans with Separate Medical and Prescription Drug Deductible

12%

33% 34% 33%

88%

67% 65% 67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Coinsurance

Copayment








Average Copayment for Specialty Drugs

$174 $179

$160

$139

$0

$20

$40

$60

$80

$100

$120

$140

$160

$180

$200









Distribution of Copayment Amounts for Specialty Drugs

16% 8%

15%

39%

25% 47%

58%

23%

39%

23%

13%

28%

12% 14%

5% 2%

8% 8% 8% 8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Over $250

>$200 - $250

>$150 - $200

>$100 - $150

$100 or less








Average Coinsurance Rates for Specialty Drugs

36% 36%

30%

28%

0%

5%

10%

15%

20%

25%

30%

35%

40%









Distribution of Coinsurance Rates for Specialty Drugs

2% 4% 7% 8%

15% 17%

19% 11%

27% 23%

45% 52%

56% 56%

30% 29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


>30% - <50%

>20% - 30%

>10% - 20%

10% or less







Prescription Drug Cost Sharing

Health & Medicine

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