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Plan
Design Configurations
Employers and PBMs use fairly standard terminology to identify cost
share amounts.
Table 9 illustrates how the industry categorizes or groups drugs for
cost sharing and reimbursement purposes. Managed care’s original,
tiered drug benefit, with generic and brand-name drug categories,
has been replaced with three-, four- and five-tier configurations
(see Table 10).
Plan designs with three or more tiers are used by 75.3 percent of
employers. The most commonly used cost sharing approach is a three-tier
plan design (generics, preferred brands and nonpreferred brands).
Tables 11 to 17 provide the average copayment and coinsurance amounts
for the two-, three- and four-tier plan designs for both retail and
mail dispensing channels.
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