RT Journal A1 Steinwachs DM T1 PHarmacy benefit plans and prescription drug spending JF JAMA JO JAMA YR 2002 FD October 9 VO 288 IS 14 SP 1773 OP 1774 DO 10.1001/jama.288.14.1773 UL http://dx.doi.org/10.1001/jama.288.14.1773 AB Health care costs are increasing rapidly again. A recent employer survey reported that health insurance premiums increased 12.7% from 2001 to 2002, the largest increase since 1990.1 The fastest rising component of health care costs is pharmaceuticals. From 1999 to 2000, national expenditures for prescription drugs increased 17.3% overall, and 19.6% for private insurance.2 Since the late 1990s, when prescription costs began rising more rapidly than other health care costs, employers have been working with their insurers and pharmacy benefit managers to develop prescription drug coverage plans that would better control costs. Many employers now offer 2- or 3-tier prescription drug coverage plans, with the amount of out-of-pocket cost increasing from bottom to top tiers. Although plans vary, the lowest tier usually includes the low-cost generic drugs, the second tier may include brand-name drugs for which no generic exists, and the third tier brand-name drugs for which generic substitutes do exist.