Specialty Tiers

In recent years, health care insurers have developed Specialty Tiers, otherwise known as Tier IV, V, and VI, a new classification of specialty drugs that requires health insurance beneficiaries to pay 20 - 35% of the cost of the drug. This approach is markedly different from traditional drug tiers with transparent and fixed co-payments, ranging from a Tier I generic at $10, to a Tier II preferred brand at $30, and a Tier III brand name drug at $50.   Most commonly health insurance companies use this new classification for infused or injected drugs prescribed and administered to patients with acute and chronic diseases, such as rheumatoid arthritis, multiple sclerosis (MS), AIDS/HIV, psoriasis, Crohn’s disease, immune disorders, hepatitis, anemia, and certain types of cancer.  

Committed to ensure full access to quality care for their members, all 17 voluntary health agencies formed the Specialty Tiers Coalition to inform legislators of the dangers of Specialty Tiers cost-shifting and to take steps to address the issue. 

The Specialty Tiers Coalition has written a letter to Georgia's Pharmacy Caucus asking for their support to stop this cost-shifting and discriminatory practice that make these life-saving, life-enhancing medications cost-prohibitive for patients.

A Call to Action for all Georgians was launched by Coalition members this year to gather stories from patients taking Specialty Tier medications and having difficulty paying the monthly cost of their drugs, as set by their health plan. The Coalition is also eager to hear from patients and their families how this growing trend is affecting their quality of life. 

The Specialty Tiers Coalition is also collaborating with patient advocacy groups across the country to support the passing of the Patient Access to Critical Therapies Act (PACTA), legislation sponsored by Rep. David McKinley (R-WV) that serves to address the restrictions Specialty Tiers impose on access to quality care for the acute and chronically ill, and H.R. 361, proposed legislation sponsored by Rep. Hank Johnson to stop Specialty Tier cost-shifting for Medicare beneficiaries. 

The Coalition will continue its efforts to ask for legislation that will allow all Georgians to have full access to their medications without imposing drug tiers based on expense or disease categories.

Please see the Specialty Tier Coalition publications below for more information on the Coalition's activities.

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Respond to this CALL TO ACTION. Stop the increase in cost of specialty tier drugs.

1. Know the facts. Read the Specialty Tiers Coalition of Georgia's fact sheet "Specialty Tiers: What do they mean for Georgia?" to know the facts about specialty tiers and how they restrict access to medication for patients with chronic diseases.

2. Share your story. Tell the Georgia community how the increase in the cost of your medication due to Specialty Tiers classification has impacted you or your loved ones. Share your story on the Specialty Tiers Story Submission webpage or email your story directly to ARxC at 
dlg@wisdomofwellnessproject.com. If you have any questions or concerns please contact ARxC directly.

Unsure what to say in your story? Read Heidi's Story for an example of how specialty tiers could affect Heidi's ability to manage her Rheumatoid Arthritis.

http://www.freedigitalphotos.net/images/view_photog.php?/Image: renjith krishnan / FreeDigitalPhotos.net