Specialty Tier Drugs

WHAT TO KNOW
The Cost of Specialty Tiers

What are Specialty Tier Drugs?

A typical plan will have price differences between non-preferred, preferred, and specialty tier medications.

Preferred drugs are the most affordable type of brand-name medications.

Non-preferred drugs are more expensive than preferred drugs and carry a higher portion of cost- sharing that the patient must pay.

Specialty tier drugs cost more than non-preferred drugs, and have no generic or similar medicine that could be taken instead.

Very Common Problem

• 87% of stand-alone Medicare Part D Prescription Drug Plans and 98% of Medicare Advantage-Prescription Drug Plans use specialty tiers, and this can be very expensive for those in need of special medicines.

What are Co-Payments and Co-Insurance?

A co-payment is a cost that a patient must pay for a drug that is a set dollar amount. Coinsurance is a cost that a patient must pay for a drug that is a percentage of the total cost for a drug. Both of these are known as cost sharing. Coinsurance can be as high as 50% for non-preferred drugs and 33% for specialty tier drugs.

• Patients who need non-preferred or specialty tier drugs often go into medical debt and bankruptcy in efforts to continue their life-saving treatment. If we can contain costs it helps the patient avoid medical debt and continue monthly treatment. When patients stay on their treatments it helps it saves them from potential loss of productivity. It also saves the nation billions of dollars in direct costs to the health care system.