According to Robert Taketomo, president and CEO of Ventegra, an example of a three-tier injectable benefit design (all tiers subject to a standard deductible and out-of-pocket maximum) would be:
According to Robert Taketomo, president and CEO of Ventegra, an example of a three-tier injectable benefit design (all tiers subject to a standard deductible and out-of-pocket maximum) would be:
The case for injectables
Injectable drugs have been traditionally covered under a medical benefit design with little or no copayment. "With the dramatic increase in the numbers of injectable products being brought to market, health plans are grappling with this issue by shifting coverage for some of these drugs into the pharmacy benefit," Taketomo says. He believes that there are a number of reasons that justify moving injectable drugs into a pharmacy benefit:
