Citizen Action of Wisconsin
Press Release

Prescription Drug Deductibles Vary from $400 to $2,500 between Wisconsin Cities

Report finds consumer exposure to drug costs vary widely by region

By - Oct 8th, 2015 01:09 pm

STATEWIDE: On a media call today Citizen Action of Wisconsin and State Senator Dave Hansen released a new report on the consumer cost of prescriptions drugs in Wisconsin.
The report documents prescription drug cost variations between 20 major Wisconsin metropolitan areas in both average deductibles, average out-of-pocket maximums, on the most common health plan.
Key Findings

  • Prescription drug deductibles range from $400 to $2,500 depending on metro area.
  • Average out-of-pocket maximums have gone up 7.9% statewide since last year.
  • What consumers pay for one month of the expensive drug “Pomalyst” in the most common insurance plan ranges from $453 in Madison to $5,375 in La Crosse.

Figure 1: Average prescription drug deductible by Metro, 2015.

METRO Average Deductible Percent over Madison
1. Madison $400
2. Janesville $454 13.50%
3. Eau Claire $750 87.50%
4. Waukesha $907 126.75%
5. Superior $1,150 187.50%
6. Wausau $1,244 211.00%
7. Fond du Lac $1,261 215.25%
8. Stevens Point $1,306 226.50%
9. Green Bay $1,414 253.50%
    Manitowoc $1,414 253.50%
    Sheboygan $1,414 253.50%
12. La Crosse $1,463 265.75%
13. Rhinelander $1,500 275.00%
14. Appleton $1,553 288.25%
15. Kenosha $1,600 300.00%
16. Milwaukee $1,699 324.75%
     Racine $1,699 324.75%
18. Hudson $1,950 387.50%
19. Wis Rapids $2,309 477.25%
20. Oshkosh $2,547 536.75%
STATEWIDE $1,121 180.25%

Figure 2: Average Out of Pocket Maximum by City can be found here

Figure 3: Percent change in average deductible and out of pocket maximum by City, 2014 to 2015 can be found here

Figure 4: Out of Pocket Test with one month of expensive drug.
To determine what consumers pay for very expensive drug, we compared the most common insurance plan in a region with what consumers would pay between premiums, deductibles and co-pays/co-insurance for the cancer drug “Pomalyst,” which costs $10,500 for a 30 day supply.

METRO Expensive Drug test
1. Madison $453.73
2, Janesville $453.82
3, Wausau $2,807.12
4. Rhinelander $2,850.32
5. Eau Claire $3,629.38
6. Superior $3,661.24
7. Wis Rapids* $3,814
8. Stevens Point* $3,814.26
9. Appleton $4,271.68
    Sheboygan $4,271.68
11. Green Bay $4,274.41
     Manitowoc $4,274.41
13. Kenosha $4,314.44
     Racine $4,314.44
15. Milwaukee $4,332.63
16. Oshkosh $4,673.46
17. Waukesha* $4,800
18. St Croix $5,198.88
19. Fond Du Lac* $5,270.55
20. La Crosse $5,375.19

“The public wants our elected leaders to turn the page on divisive efforts to repeal the Affordable Care Act, and work together to bring down skyrocketing prescription drug costs,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin. “It is stunning that prescription drug prices have increased 141% since 2008 without any meaningful response from lawmakers in Madison and Washington.”

“This is not only about insurance companies pushing more of the burden on consumers,” said State Senator Dave Hansen (D-Green Bay). ”It’s about how excessive prescription drug prices have become and how state government must step in to protect consumers. No one person can take on both the insurance industry and drug companies on their own.“

The full report can be viewed here

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