PRESCRIPTIONS: Two-Thirds Covered By Managed Care Plans
Managed care plans now help pay for 64.5% of prescriptions at U.S. retail pharmacies, as more Americans move into private and Medicaid managed care plans, according to a new report from IMS Health. As managed care's share of prescriptions increased from 59.8% in 1997, Medicaid's share decreased, from 11.1% of prescriptions in 1997 to 10.4% in 1998. Prescriptions paid with cash have also dipped sharply, from 63.1% in 1990 to 50% in 1993 to the current 25%. Paul Allen, vice president of product marketing for IMS, said, "This pace of change is tapering off, as third party plans [including managed care] reach a maximum share level for the prescription drug market." However, Myron Holubiak of IMS' Plymouth Group said, "We will see more of the population moving into the managed care environment." He predicted that over the next five years, the percentage of the Medicaid population in managed care plans will nearly double from 43% to 83%, and that over the same span the total number of Americans in private managed care plans will increase from 27% today to 46% in 2004. As managed care plans struggle to deal with rising consumer demand for a wide range of pharmaceuticals, "[t]he trend just beginning" in prescription payments, Holubiak said, "is triple tier copays -- a small copay for a generic prescription, an increased copay for a branded formulary product and an even higher copay for a branded non- formulary product. The result is a rising price sensitivity by consumers" (IMS release, 8/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.