Although per capita patient out-of-pocket (OOP) spending on prescription medications has dropped, averages are deceiving. In the U.S., a modest percentage of patients are burdened with unsustainable OOP biopharmaceutical spending. These are the patients who depend on brand-name medicines that have no generic or biosimilar equivalents. The primary contributor to the OOP burden is the changing of pharmaceutical benefit design. Such evolution from fixed-cost co-payments to percentage-based coinsurance and the expansion of high-deductible plans has dramatically increased the OOP share of drug costs paid by those patients.
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