New data show patients’ out-of-pocket costs are rising faster than their insurers’ costs

Holly Campbell   |     July 9, 2018   |   SHARE THIS

Newly released data from the Kaiser Family Foundation show out-of-pocket costs for patients with employer-sponsored health insurance rose faster than the costs paid by their insurers between 2006 and 2016. Over this decade, the total amount patients spent out of pocket grew, on average, from $525 to $806. That increase of 54 percent is higher than the increase in payments by health insurers, which rose 48 percent, on average, over the same time period (from $3,182 to $4,724).

In addition, from 2006 to 2016:

  • Average patient payments toward deductibles rose from $151 to $417, an increase of 176 percent.
  • Average patient payments toward coinsurance -- a percentage of costs a patient is responsible for paying out of pocket -- rose from $149 to $249, an increase of 67 percent.
  • Average patient payments toward copays – a fixed cost – decreased 38 percent from $225 to $140.


As patient out-of-pocket costs increase dramatically and cost-sharing shifts from fixed copays to less predictable deductibles and coinsurance, patients will continue to face affordability challenges. Even though rebates paid by biopharmaceutical companies often substantially reduce what insurers and pharmacy benefit managers (PBMs) pay for medicines, insurers typically use list prices—rather than discounted prices—to determine how much to charge patients with deductibles and coinsurance. In 2017, more than half of patient out-of-pocket spending for brand medicines was for prescriptions filled in the deductible or with coinsurance. No patient should pay more for their medicine than their insurer.

Learn more at LetsTalkAboutCost.org.

Holly Campbell

Holly Campbell Holly Campbell is former deputy vice president of public affairs at PhRMA focusing on the cost and value of medicines. Prior to joining PhRMA, Holly worked for large and small public relations firms where she provided strategic communications counsel, media relations and partnership expertise to health care and pharmaceutical clients. In her free time, she enjoys taking barre classes, trying new restaurants and spending time with Boss and Poppy, her rescue pups.

Topics: Drug Cost, Out-of-Pocket Costs, Let's Talk About Cost

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