Prescription drug cost sharing

1. Prescription Drug Cost Sharing

2. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Generic Prescriptions Plans
with Combined Medical and Prescription Drug Deductible
5%
9%
33%
11%
8%
33% 67%
73%
88%
34%
16%
9% 12%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copayment & Coinsurance
Coinsurance
Copayment
No Charge after Deductible
No Charge

3. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Generic Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
1% 3% 4%
94%
95% 95% 100%
4%
1% 1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Coinsurance
Copayment
No Charge

4. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Average Copayment for Generic Drugs (includes plans with
'copayment' or 'both copayment & coinsurance')
$19
$12
$10
$8
$0
$2
$4
$6
$8
$10
$12
$14
$16
$18
$20
Bronze Silver Gold Platinum

5. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Generic Drugs
(includes plans with 'copayment' or 'both copayment & coinsurance')
2%
17%
28%
38%
27%
35%
46%
54%
13%
33%
19%
7%
24%
9%
5%
2%
16%
4%
2%
18%
2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $25
>$20 - $25
>$15 - $20
>$10 - $15
>$5 - $10
$5 or less

6. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Generic Drugs (includes plans with
'coinsurance' or 'both copayment & coinsurance')
33%
25%
20%
38%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Bronze Silver Gold Platinum

7. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Generic Drugs (includes plans
with 'coinsurance' or 'both copayment & coinsurance')
7%
28%
64%
28%
33%
5%
19%
12%
9%
50%
18%
9%
9%
29%
17%
14%
50%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
40% or more
>30% - 40%
>20% - 30%
>10% - 20%
10% or less

8. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Preferred Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
38%
13%
9%
20%
61% 70%
76%
42%
26%
21% 24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Coinsurance
Copayment
No Charge after Deductible

9. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Preferred Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
87% 90% 90%
96%
13% 10% 10%
4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Coinsurance
Copayment

10. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Average Copayment for Preferred Drugs (includes plans with
'copayment' or 'both copayment & coinsurance')
$67
$48
$39
$30
$-
$10
$20
$30
$40
$50
$60
$70
$80
Bronze Silver Gold Platinum

11. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Preferred Drugs (includes
plans with 'copayment' or 'both copayment & coinsurance')
5%
23%
3% 5%
25%
53%
13%
30%
40%
16%
28%
48%
25%
9%
8%
11%
4%
48%
6%
1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $60
>$50 - $60
>$40 - $50
>$30 - $40
>$20 - $30
$20 or less

12. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Preferred Drugs (includes plans with
'coinsurance' or 'both copayment & coinsurance')
36%
30%
27%
23%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Bronze Silver Gold Platinum

13. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Preferred Drugs (includes plans
with 'coinsurance' or 'both copayment & coinsurance')
4%
13% 16%
33%
17%
23%
21%
17%
26%
25%
37%
33%
19%
15%
14%34%
23%
11%
17%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
40% or more
>30% - 40%
>20% - 30%
>10% - 20%
10% or less

14. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
37%
17% 15%
8%
23%
33%
71%
50%
54%
52%
29%
5% 6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copayment & Coinsurance
Coinsurance
Copayment
No Charge after Deductible

15. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
62% 61% 59%
71%
38%
28%
28%
29%
11% 13%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copayment and Coinsurance
Coinsurance
Copayment

16. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Average Copayment for Non-Preferred Drugs (includes plans with
'copayment' or 'both copayment & coinsurance')
$124
$98
$83
$66
$0
$20
$40
$60
$80
$100
$120
$140
Bronze Silver Gold Platinum

17. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Non-Preferred Drugs
(includes plans with 'copayment' or 'both copayment & coinsurance')
4% 4% 7%
29%
15%
24%
51%
60%
26%
42%
30%
9%
36%
27%
9%
20%
3% 3%
2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $150
>$100 - $150
>$75 - $100
>$50 - $75
$50 or less

18. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Non-Preferred Drugs (includes plans
with 'coinsurance' or 'both copayment & coinsurance')
37%
34%
32%
37%
29%
30%
31%
32%
33%
34%
35%
36%
37%
38%
Bronze Silver Gold Platinum

19. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Non-Preferred Drugs
(includes plans with 'coinsurance' or 'both copayment & coinsurance')
3% 6%
12%
21%
33%
32%
6%
13%
14% 8%
11%
61%
45% 48%
83%
2% 1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Greater than 50%
>30% - 50%
>20% - 30%
>10% - 20%
10% or less

20. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Specialty Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
38%
18% 15%
5%
12%
14% 47%
52%
63%
70%
53%
5% 7%
1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copayment and Coinsurance
Coinsurance
Copayment
No Charge after Deductible

21. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Specialty Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
32%
22% 20%
29%
68%
66% 68%
71%
12% 13%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copayment and Coinsurance
Coinsurance
Copayment

22. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Average Copayment for Specialty Drugs (includes plans with
'copayment' or 'both copayment & coinsurance')
$268
$258
$194 $193
$0
$50
$100
$150
$200
$250
$300
Bronze Silver Gold Platinum

23. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Specialty Drugs (includes
plans with 'copayment' or 'both copayment & coinsurance')
7% 9%
24%
41%
11%
12%
17%
9%
19% 13%
17%
15%
37%
26%
5%
49%
29%
16%
45%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $250
>$200 - $250
>$150 - $200
>$100 - $150
$100 or less

24. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Specialty Drugs (includes plans with
'coinsurance' or 'both copayment & coinsurance')
38%
34%
32%
34%
29%
30%
31%
32%
33%
34%
35%
36%
37%
38%
39%
Bronze Silver Gold Platinum

25. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 38 states with Federally Facilitated or Partnership exchanges in 2016
(including Hawaii, New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available
here: https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Specialty Drugs (includes plans
with 'coinsurance' or 'both copayment & coinsurance')
3% 6% 9%
14%
21%
22%
27%
21%
31%
27%
17%
60%
43% 42%
56%
1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
50% or Greater
>30% - 50%
>20% - 30%
>10% - 20%
10% or less