Health Insurance for Prescription Drugs in the United States

HEALTH INSURANCE FOR PRESCRIPTION DRUGS IN THE UNITED STATES 

All public and private health insurers in the United States distinguish between inpatient, outpatient, and home health insurance benefits. So, whether or not an individual has insurance coverage for a prescription drug depends not only on whether he or she has health insurance but also on the setting in which the drug is prescribed and administered. Inpatient benefits cover services and products used in hospitals and sometimes in nursing homes. Outpatient benefits are for services or products obtained in clinics or offices of health professionals home health care benefits are for services or products provided by certified personnel to patients at home.2 

SOURCE IMS America, Inc., as cited in F-D-C-Reports Prescription and OTC Pharmaceuticals, Mail Order Grew 37% to 2.9 Bil. in 1991 IMS Survey Growth May Slow Soon, p. 11, Mar. 16, 1992. 

Most Americans-86 percent-have public or private health insurance, continuing a steady trend over the last decade (292). Virtually all health insurance plans cover hospital care, including drugs dispensed to hospitalized patients. 

Sales to hospitals made up about 23 percent of total U.S. pharmaceutical sales in 1991 (128), a decline from about 29 percent in 1983 (291,320). (See figure 10-1 for a breakdown of pharmaceutical sales by type of buyer at the wholesale level.) A growing proportion of these sales represent drugs sold through hospital-based outpatient pharmacies,3 so the inpatient hospital share of the pharmaceutical market today is actually below 23 percent. 

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