Patients with Exchange Plans Pay 2x Out Of Pocket for Rx
The analysis reviewed the prevalence of combined medical and pharmacy deductibles, compared standard types of plan designs for Silver plans and employer-sponsored plans, assessed member
cost sharing as a result of combined deductibles, and modeled the difference in actuarial value by benefit category as a result of combined deductibles.
Data from the Kaiser Family Foundation and Health Research and Educational Trust Employer Health Benefits 2013 Annual Survey and www.healthcare.gov were used to develop typical plan designs. A typical Silver plan, reflective of the median or average benefit plan provisions for each type of plan referenced in the study, was developed by Milliman for this analysis. A mix of medians and averages (means) were used to ensure that the overall plan design met the actuarial value requirement for a Silver plan.
The Silver plan designs were run through the final 2015 AV Calculator, released by the Centers for Medicare and Medicaid Services (CMS) on March 4, 2014, to ensure the designs met the requirements of being a Qualified Silver plan. Milliman’s proprietary Claims Simulation Model was then used to calculate the actuarial value amounts and member cost sharing percentages that were used in the remainder of the analysis.
The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading innovative biopharmaceutical research and biotechnology companies, which are devoted to discovering and developing medicines that enable patients to live longer, healthier, and more productive lives. Since 2000, PhRMA member companies have invested more than $550 billion in the search for new treatments and cures, including an estimated $51.1 billion in 2013 alone.
Milliman is among the world’s largest providers of actuarial and related products and services. The firm has consulting practices in healthcare, property & casualty insurance, life insurance and financial services, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. For further information, visit www.milliman.com.