This document analyzes prescription drug cost sharing structures in health insurance plans from the ACA marketplaces in 2015. It finds that bronze level plans generally had higher copays and coinsurance rates compared to silver, gold, and platinum plans. For generic drugs, over 50% of bronze plans had copays of $10 or less, decreasing to around 25% for silver and higher metal level plans. Specialty drug costs were highest, with average copays of $174-179 and over 50% of bronze plans having copays over $150.

1. Prescription Drug Cost Sharing

2. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Generic Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
5%
1%
21%
46%
48%
38% 28%
25%
34%
12%
18%
22%
28%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copayment & Coinsurance
Coinsurance
Copayment
No Charge after Deductible

3. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Generic Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
17% 20%
2%
98%
82% 78%
97%
2% 1% 1% 1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Coinsurance
Copayment
No Charge

4. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayment for Generic Drugs
$19
$13
$10
$8
$0
$2
$4
$6
$8
$10
$12
$14
$16
$18
$20
Bronze Silver Gold Platinum

5. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Generic Drugs
5%
11%
15%
33%
11%
34%
55%
67%
22%
37%
24%
1%
26%
15%
6%
25%
3%
0%
11%
1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $25
>$20 - $25
>$15 - $20
>$10 - $15
>$5 = $10
$5 or less

6. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Generic Drugs
30%
29%
23%
26%
0%
5%
10%
15%
20%
25%
30%
35%
Bronze Silver Gold Platinum

7. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Generic Drugs
13%
17%
38%
20%
19%
34%
20%
10%
37%
20%
23%
50%
7% 4%
5%
0%
24% 25%
15%
20%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
40% or more
>30% - >50%
>20% - 30%
>10% - 20%
10% or less

8. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Preferred Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
36%
17%
8%
26%
58%
69%
91%
38%
26% 23%
9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Coinsurance
Copayment
No Charge after Deductible

9. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Preferred Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
81%
94% 93%
99%
19%
6% 7% 1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Coinsurance
Copayment

10. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayment for Preferred Drugs
$63
$47
$37
$28
$-
$10
$20
$30
$40
$50
$60
$70
Bronze Silver Gold Platinum

11. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Preferred Drugs
7%
25%
2% 5%
27%
57%
6%
24%
48%
13%
47%
58%
13%
4%
6%
9%
4%
39%
3% 2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $60
>$50 - $60
>$40 - $50
>$30 - $40
>$20 - $30
20% or less

12. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Preferred Drugs
32%
30%
27% 27%
24%
25%
26%
27%
28%
29%
30%
31%
32%
33%
Bronze Silver Gold Platinum

13. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Preferred Drugs
2%
10%
17% 18%
24%
19%
12%
36%
39%
52%
64%
11%
11%
8%27%
22%
11%
18%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
40% or more
>30% - >40%
>20% - 30%
>10% - 20%
10% or less

14. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
36%
20%
8%
20%
40%
52%
88%
44%
40% 40%
11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Coinsurance
Copayment
No Charge after Deductible

15. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Non-Preferred Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
56%
75% 78%
69%
44%
25% 22%
31%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Coinsurance
Copayment

16. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayment for Non-Preferred Drugs
$106
$85
$74
$55
$0
$20
$40
$60
$80
$100
$120
Bronze Silver Gold Platinum

17. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Non-Preferred Drugs
1% 4%
8%
60%
34%
47%
66%
35%
30%
39%
22%
4%
27%
9%
2%8%
1% 2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $150
>$100 - $150
>$75 - $100
>$50 - $75
$50 or less

18. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Non-Preferred Drugs
37% 37%
34%
33%
31%
32%
33%
34%
35%
36%
37%
38%
Bronze Silver Gold Platinum

19. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Non-Preferred Drugs
2%
6%
13%
3%
17%
22%
19%
10%
29%
15% 10%
16%
51%
56% 58%
71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
>30% - <50%
>20% - 30%
>10% - 20%
10% or less

20. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Specialty Prescriptions
Plans with Combined Medical and Prescription Drug Deductible
36%
22%
10%
1%
3%
9%
8%
1%
61%
68%
82%
98%
1% 1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Copayment and Coinsurance
Coinsurance
Copayment
No Charge after Deductible

21. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Share of Plans by Type of Cost Sharing for Specialty Prescriptions
Plans with Separate Medical and Prescription Drug Deductible
12%
33% 34% 33%
88%
67% 65% 67%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Coinsurance
Copayment

22. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Copayment for Specialty Drugs
$174
$179
$160
$139
$0
$20
$40
$60
$80
$100
$120
$140
$160
$180
$200
Bronze Silver Gold Platinum

23. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Copayment Amounts for Specialty Drugs
16%
8%
15%
39%
25%
47%
58%
23%
39%
23%
13%
28%
12% 14%
5% 2%
8% 8% 8% 8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
Over $250
>$200 - $250
>$150 - $200
>$100 - $150
$100 or less

24. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Average Coinsurance Rates for Specialty Drugs
36% 36%
30%
28%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Bronze Silver Gold Platinum

25. SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2015
(including New Mexico, Oregon, and Nevada). Data are from Healthcare.gov Health plan information for individuals and families available here:
https://www.healthcare.gov/health-plan-information/
Distribution of Coinsurance Rates for Specialty Drugs
2% 4% 7% 8%
15%
17%
19%
11%
27%
23%
45%
52%
56% 56%
30% 29%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bronze Silver Gold Platinum
>30% - <50%
>20% - 30%
>10% - 20%
10% or less