Over the years, insurers have tried--with varying degrees of success--to rein in prices and moderate the costs of prescription drugs. But to ensure consumers can afford specialty tier drugs, a new issue brief from the Robert Wood Johnson foundation recommends payers team up with state and federal regulators to combat the soaring prices.
The most commonly-used method to emerge from the prescription drug-cost debate involved benefit tiers, according to the brief. Early on, the idea was fairly simple. The design was two-tiered, with generic drugs on the first tier (and lower copayments) and brand name drugs on the second tier (and higher copayments).
But soon came the addition of a third tier, often more expensive alternatives to the first and second tier drugs, with some plans offering as many as six tiers. For individuals with a chronic or serious disease, regulators examine the drug costs for who needs them the most, and whether the tiered model violates the anti-discrimination provision of the Affordable Care Act, the authors of the report write.
Many states introduced legislation to limit cost-sharing for specialty drugs. Delaware and Maryland, for example, have a $150 cap for a 30-day supply of a single-specialty tier drug. On the federal level, U.S. Rep. David B. McKinley (R-WV) introduced an initiative this past February to establish cost-sharing limits for health plans that cover prescription drugs, notes the report.
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By Dori Zweig