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
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.
In this video, hear from 50-State Network advocates Cameron and Craig, along with other patients, who have overcome remarkable denials to PCSK9 Inhibitors.
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.