Average Number of Prescriptions by HMOs Increases
Average Number of Prescriptions by HMOs Increases
Between 1999 and 2000, the average copayment per prescription climbed 42.7% for formulary brand-name drugs and 31.3% for nonformulary brand-name drugs, according to the Aventis HMO-PPO/Medicare-Medicaid Digest 2001. The average copayment for generic drugs increased only 11.5% from the previous year.
Average overall HMO drug expenditures per member per year increased 19.6% in 2000, to $243.42 from $203.52 in 1999. Pharmaceutical expenditures accounted for 13.4% of total HMO operating costs in 2000, unchanged from 1999.
The share of HMOs that reviewed their drug formularies annually increased to 25.1% in 2000 from 17.5% in 1999. Formularies were reviewed quarterly by 39.3% of HMOs, up notably from 35.1% the previous year. PBMs were named as members of drug formulary committees by 46.1% of HMOs, down from 51.9% in 1999. Similarly, HMO administrators were members of formulary committees at just 22.6% of HMOs, a significant drop from 30.5% the previous year (cover).
The average number of prescriptions dispensed per non-Medicare HMO member per year rose 5.6% in 2000, to 7.5 from 7.1 in 1999, while the average number dispensed for Medicare members increased 5.5%, to 19.1 from 18.1 (Figure).
(Enlarge Image)
In 2000, network-model HMOs dispensed the most prescriptions per member per year (PMPY) for non-Medicare (7.7) and Medicare (19.7) members alike. (IPA, independent practice association.)
Other highlights from the digest include:
Data for the figure on the cover and in "Trend of the Month" are from the HMO-PPO/Medicare-Medicaid Digest 2001, one of the 4-part Aventis Pharmaceuticals Managed Care Digest Series. Most data for the digest were gathered by SMG Marketing Group Inc. The series is available online at: www.managedcaredigest.com.
Between 1999 and 2000, the average copayment per prescription climbed 42.7% for formulary brand-name drugs and 31.3% for nonformulary brand-name drugs, according to the Aventis HMO-PPO/Medicare-Medicaid Digest 2001. The average copayment for generic drugs increased only 11.5% from the previous year.
Average overall HMO drug expenditures per member per year increased 19.6% in 2000, to $243.42 from $203.52 in 1999. Pharmaceutical expenditures accounted for 13.4% of total HMO operating costs in 2000, unchanged from 1999.
The share of HMOs that reviewed their drug formularies annually increased to 25.1% in 2000 from 17.5% in 1999. Formularies were reviewed quarterly by 39.3% of HMOs, up notably from 35.1% the previous year. PBMs were named as members of drug formulary committees by 46.1% of HMOs, down from 51.9% in 1999. Similarly, HMO administrators were members of formulary committees at just 22.6% of HMOs, a significant drop from 30.5% the previous year (cover).
The average number of prescriptions dispensed per non-Medicare HMO member per year rose 5.6% in 2000, to 7.5 from 7.1 in 1999, while the average number dispensed for Medicare members increased 5.5%, to 19.1 from 18.1 (Figure).
(Enlarge Image)
In 2000, network-model HMOs dispensed the most prescriptions per member per year (PMPY) for non-Medicare (7.7) and Medicare (19.7) members alike. (IPA, independent practice association.)
Other highlights from the digest include:
The share of HMOs that covered OTC medications rose sharply, to 29.0% from 12.3% in 1999.
The share of HMOs that required generic substitution when generic products were available grew to 82.1% in 2000 from 76.9% in 1999, while the share of HMO members subject to generic substitution increased to 85.2% from 82.4%.
The percentage of reporting HMOs that had formal drug utilization programs continued to rise in 2000, to 96.2% from 93.9% in 1999 and 92.6% in 1998.
The share of HMOs that used mail-order pharmacies was 82.8% in 2000, virtually unchanged from 82.7% in 1999.
Data for the figure on the cover and in "Trend of the Month" are from the HMO-PPO/Medicare-Medicaid Digest 2001, one of the 4-part Aventis Pharmaceuticals Managed Care Digest Series. Most data for the digest were gathered by SMG Marketing Group Inc. The series is available online at: www.managedcaredigest.com.
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