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Marketplace Pulse: Prescription Drug Benefits
Robert Wood Johnson Foundation 
Dec. 21, 2020 "There are major differences between ACA plans and large group employer coverage when it comes to drug benefits. Individual and small group plans both have more formulary tiers than large group plans. Nearly all (95%) of individual market and 93 percent of small group plans have four or more tiers compared with 54 percent of traditional employer plans and 36 percent of high deductible employer plans. More tiers translates into higher out of pocket costs, since patient cost-sharing is higher for brand and specialty drugs." |
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