The average reported group size is 21,340 for the active employees in 2011 (Table 1). This figure compares to an average size of 9,736 in 2010, a reflection of the decrease in participation among small employers (Table 2) and perhaps reflecting lower rates of medical benefits among smaller employers. Employers with 4,000 lives or less represented 54% of respondents in 2010 compared to only 44% in 2011. Significant differences by employer size are highlighted in the report.
Figure 3 illustrates the types of drug benefit structure used by responding employers. Sixty percent of the employers have a self-insured plan while 33% were fully-insured. Of the fully-insured employers, 58% had 2,000 or less employees, compared to 23% of the self-insured employers (p<.05). Insurance carriers and managed care organizations hold most of the financial risk for fully-insured plans whereas self-insured employers have more financial risk and responsibility and usually play a more active role in the day-to-day management of their drug benefit programs. Significant differences in self-insured and fully-insured plans are noted throughout the report.
The number of carve-in (same company administers the drug and medical benefit program) and carve-out (different companies administer the drug and medical benefit program) designs is similar, as shown in Figure 4. Sixty-six percent of self-insured plans carved out their pharmacy benefit, compared to 27% of fully-insured employers (p<.05). Fifty-four percent of carve-in plans had 2,000 lives or less, compared to 19% of carve-out plans (p<.05). Differences between carve-in and carve-out plans are found in the report.
For 2011, 38% of respondents said they were considered a "grandfathered plan" under health reform while 19% did not know their status (Figure 5). Among other requirements, a grandfathered plan was in existence on March 23, 2010, the date of health care reform enactment. Grandfathered plans have different requirements for various coverage requirements implemented under health reform.
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