Outpatient prescription drug benefits for workers in educational services in 2020

Forty-nine percent of private industry workers in educational services participated in outpatient prescription drug plans in March 2020. All of the educational services workers participating in these plans had coverage for generic drugs and brand-name drugs on formulary. Formulary drugs are those approved by the healthcare provider. Drugs not approved by the healthcare provider are called nonformulary drugs, for which enrollees receive less generous benefits, such as a higher copayment. Coverage for brand-name nonformulary drugs was available to 96 percent of educational services workers. Coverage for mail-order drugs was available to 91 percent.

Eighty percent of workers in educational services had to pay a copayment for generic drugs, and 12 percent had to pay coinsurance. The median coinsurance was 80 percent. Copayments are the fixed dollar amount that an insured person must pay when receiving a service, before the insurer pays any remaining charges. Coinsurance is the amount an insured person must pay for a service, stated as a percentage of medical expenses.

Eighty-one percent of workers in educational services had to pay a copayment for formulary brand-name drugs. The median copayment was $35. A coinsurance was required for 17 percent of workers, with a median coinsurance of 70 percent.

Eighty-two percent of educational services workers had to pay a copayment for nonformulary brand-name drugs. The median copayment was $60. A coinsurance was required for 16 percent of workers, with a median coinsurance of 55 percent.

These data are from the National Compensation Survey — Benefits program. For more information, see Health care plan provisions for private industry workers in the United States, 2020, and the complete benefits dataset (XLSX). To learn more about terms related to employee benefits, see our glossary.