Consumers Face Higher Costs as Health Plans Seek to Control Drug Spending

This HSC publication notes that insured consumers may face sticker shock at pharmacy counters as health plans take more aggressive steps, such as three-tier pharmacy benefits, to control rapidly rising drug costs. Under a three-tier design, consumers typically incur the lowest out-of-pocket costs for generic drugs, higher costs for preferred brand-name drugs, and the highest costs for nonpreferred brand drugs. Consumers have a broader choice of drugs but must pay more if they choose nonpreferred ones. The move to three-tier benefits has helped slow drug-spending growth--at least in the short term--but raises questions about cost and quality of pharmaceutical care for consumers.