Drug-specific annual deductibles, maximum annual benefits, or out-of-pocket limits are not included in the majority of employers’ plan designs. The most commonly adopted features are a drug-specific annual deductible used by 12.9% of employers and a drug-specific out-of-pocket limit used by 11.7% of employers. Only 3.8% of employers have a drug-specific maximum annual benefit.

• The median drug-specific annual deductible is $75 for single and $150 for family. A deductible is the amount a plan member pays before the plan pays for prescriptions.
• Median drug-specific out-of-pocket limit is $2,000 for single and $3,000 for family. An out-of-pocket limit is the total amount a member must pay for prescription drugs in a 12-month period.
• Median drug-specific maximum annual benefit is $3,500 for single and $5,250 for family. A maximum annual benefit is the total amount a plan will pay for prescription drugs in a 12-month period.

Download Full Prescription Drug Benefit Cost and Plan Design Report or Request Print Copies