title: Pharmacy benefit design options available to employers.
abstract: I explore all the pharmacy benefit options currently available to employers. First, I discuss the design of the benefit structure, which can involve up to five tiers of drug options and three tiers of pharmacy options. Next, I discuss how the employer can overlay a cost-sharing structure on top of that benefit structure, in order to provide each employee with the right balance of choice and incentives. The cost-sharing structure can entail up to seven main types of cost-sharing: copayments, coinsurance, incentive pricing, benefit caps, quantity caps, deductibles and defined contributions.
authors.affiliation: Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality, Suite 605, 2101 E. Jefferson St., Rockville, MD 20852, USA. wencinos@ahrq.gov
authors.forename: William E
authors.initials: WE
authors.lastname: Encinosa