Co-Payments for Generic, Preferred Brand and Non-Preferred Brand Drugs (1998-1999)

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Co-Payments for Generic, Preferred Brand and Non-Preferred Brand Drugs (1998-1999)

Over 95% of responding HMOs (236 of 248) require a co-payment for generic drugs. Over 86% require a co-payment for preferred brand drugs (211 of 244), while 63% require a co-payment for non-preferred brand drugs (144 of 228).

As seen from the figure below, co-payments for generic drugs are the cheapest, with 54% of responding HMOs (119 of 220) charging members $5.00 or less per prescription.

On average, responding HMOs had just 37.1% of their pharmacy expenses generated by generic drugs in 1998 and year-to-date 1999, indicating that 62.9% of pharmacy expenses are generated by brand name drugs. The average percent of pharmacy expenses generated by formulary drugs is also expected to remain steady between 87% and 89%.

Co-Payment	Number of HMOs
	Generic (n=220)	Preferred Brand (n=197)	Non-Preferred Brand (n=123)
$1.00-$5.00	119	17	7
$5.01-$10.00	100	74	17
$10.01-$15.00	1	71	9
$15.01-$20.00		33	10
$20.01 or more		2	80

Source: The InterStudy Publication's Press Release: HMOs Lose Over 500,000 Enrollees Since January 1, 1999, Findings from HMO Industry Report 10.1, Part II of the InterStudy Competitive Edge series.
For more information about the InterStudy Competitive Edge Series, please visit MCOL's Managed Care Store at: http://www.mcareol.com/mcolfree/mcolfre1/yinterst.htm#The Competitive Edge

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