The Joint Legislative Budget and Finance Committee Wednesday issued a report on Prescription Drug Speciality Tiers in Pennsylvania.
The report shows drugs within specialty tiers are biologic in nature without any generic equivalents and usually treat life threatening conditions. Drugs within the specialty tiers typically require the benefactor to pay a percentage of the cost of the medicine rather than a fixed cost, which the report said can be as much as $1,500.
Specialty tiers are especially prevalent in Part D Medicare plans, 90 percent of which include specialty tiers, she said the study indicates. Only 23 percent of workers’ employer- sponsored health plans include specialty tiers, though that number is growing, the report warned.
The report shows that these specialty tiers typically require the benefactor to pay 32 percent of the cost.
A survey conducted as part of the study indicates that half of the responders’ plans cap the costs, while the other half does not. Tt also shows that over 30 percent of responders reported that they chose not to take a drug because it was too expensive, and that 20 percent reported ceasing taking a drug because they could no longer afford it. Multiple statistics that show when cost sharing insurance plans puts too much money on the consumer, the rate of taking the recommended drug falls.
There are both federal and state programs to help people pay for these medicines. The PACE program, she offered, has relatively small copayments, putting the majority of the cost on the pharmaceutical companies themselves.A copy of the report is available online.