Generic Utilization Rates Continue Increasing — Compare Your Plan to the Averages

A 50% GENERIC RATE IS NO LONGER ACCEPTABLE A recent study was conducted of employer groups by the Pharmacy Benefit Management Institute (PBMI).   Here are the latest 2009-10 generic dispensing rate results:

Generic Retail Dispensing rate = 63.5%

Generic Mail Order Dispensing rate = 53.6%

"Drug benefit management indicators are trending in the right direction as a result of effective use of economic incentives and clinical tools, says Dana H. Felthouse, MBA, PBMI president. "Employer use of multiple-tier drug benefit designs continues to increase for a third year, encouraging plan member use of low cost medications when medically appropriate. Generic dispensing rates increased in both retail and mail, with the average retail rate at 63.5% and the average mail rate at 53.6%."

For the first time, the study notes differences among fully-insured, self-insured, carve-out and carve-in drug benefit programs. For example, self-insured employers and those with carve-out drug plans are most likely to use multi-tiered cost sharing. Another significant difference occurs in management of specialty pharmacy. More carve-out employers than carve-in employers offer a specialty pharmacy benefit, with carve-out employers more likely to use their PBMs as exclusive suppliers of specialty drugs.

The 2009 survey was completed by 417 U.S. employers representing more than 7 million members. Almost 70 percent of the respondents have a self-insured plan compared to 32 percent with a fully-insured plan. There's a fairly even use of carve-in and carve-out designs.

Click here for your free copy of the 2009-10 Prescription Drug Benefit Cost and Plan Design Report.