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Benefit
Limits
There does not appear to be broad usage of drug-specific annual deductibles,
maximum annual benefits, or out-of-pocket limits in the employers’
plan designs.
The most commonly adopted features are a drug-specific annual deductible
(used by 15.4% of employers) and a drug-specific out-of-pocket limit
(used by 11.6 percent of employers).
Only 6.9 percent of employers have a drug-specific maximum annual
benefit.
» The average drug-specific annual deductible is $50 for individuals
and $150 for a family. A deductible is the amount a plan member pays
before the plan pays for prescriptions.
» The average drug-specific out-of-pocket limit is $1,500 for
an individual and $2,800 for a family. An out-of-pocket limit is the
total amount a member must pay for prescription drugs in a 12-month
period.
» The average drug-specific maximum annual benefit is $1,300
for an individual and $2,775 for a family. A maximum annual benefit
is the total amount a plan will pay for prescription drugs in a 12-month
period.
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