The Pharmacy Benefit Management Institute (PBMI), an independent education and research organization, conducted its annual drug benefit plan design survey of U.S. employers from April through May 2011. PBMI supplemented its database of U.S. employers with a list of subscribers to Employee Benefits News magazine and AIS Health who are managers, directors or vice presidents of benefits. Data was collected online into a secure, password-protected database.
The comprehensive survey instrument collects information on drug plan design and utilization for prescription drugs dispensed through retail, mail-service and specialty pharmacy distribution channels. Responding to changing market dynamics, PBMI asked new questions on discounts and claim costs for retail 90 prescriptions, specialty rebates, and various pharmacy network management strategies. Respondents also answered questions about:
- Cost sharing information;
- Plan design features including Medicare Part D, specialty pharmacy, maintenance drugs, drug-specific benefit and out-of-pocket maximums;
- Per member per month utilization metrics;
- Utilization management tools;
- Specialty pharmacy management strategies;
- Genetic testing coverage;
- Affordability of prescription drugs; and
- Value-based plan design.
Completed surveys from 274 respondents representing 5.2 million members are included in the analysis. Not all employers provided their group size so the estimated number of members represented is 6.7 million. The number of members reported by a respondent is for the benefit plan for which the survey was completed, not necessarily all of the members covered by the respondent for all plans offered. For example, a steel manufacturer might complete the survey for its U.S.-based union employees but not all its employees worldwide.
The data provided underwent a quality review and any known errors were excluded from the results. Respondents were included in the results for any question for which they provided a valid response.
Subsequently, PBMI employed descriptive and inferential statistical analysis to derive the findings presented in this report. A p-value <.05 was used to report all significant differences across key subgroups of employers (e.g., fully versus self-insured). Not applicable (NA) is notated in table cells where there is no or insufficient data to report.
PBMI gratefully acknowledges the support of Takeda Pharmaceuticals North America (TPNA), Inc. for the provision of a sponsorship to cover costs incurred in the production of this report. TPNA has no access to the individual responses or raw data gathered, nor do any other third parties.
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