The proportion of people with employer-sponsored coverage whose retail drug spending exceeded $5,000 per year (including costs paid by insurance and out of pocket) increased from 1.6 percent in 2004 to 3.9 percent in 2014, while the proportion of those whose retail drug spending exceeded $20,000 per year increased from 0.1 percent to 0.8 percent, according to a report by the Peterson-Kaiser Health System Tracker.
The analysis revealed that people diagnosed with conditions such as blood diseases, cancer, conditions affecting the digestive tract, circulatory illnesses and endocrine disorders, including diabetes and obesity, are more likely to have high drug spending.
People with out-of-pocket drug spending that exceeds $1,000 annually represent less than 3 percent of all people who have coverage through large employers, the report noted, but they account for 33 percent of aggregate out-of-pocket spending on drugs.
The analysis also demonstrated a trend toward lower average out-of-pocket drug spending from 2009 to 2014 among people with coverage through large employers. Some of the decrease likely resulted from the loss of patent protection for several popular drugs, and some was associated with the provision of the ACA that makes birth control available without cost sharing.
The type of out-of-pocket drug costs shifted substantially during the period analyzed, with deductibles accounting for 24 percent of costs in 2014 (up from 4 percent in 2004) and coinsurance accounting for 20 percent of costs (up from 3 percent in 2004). In 2004, copays represented the overwhelming majority of out-of-pocket costs.
The research was based on a sample of claims from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database.