The biggest battle in healthcare these days-besides the ongoing fight over Obamacare-is over the price of expensive life-saving medications.
The biggest battle in healthcare these days—besides the ongoing fight over Obamacare—is over the price of expensive life-saving medications.
The fight centers on how drug benefits are designed in health plans, particularly the use of benefit tiers. Health plans usually put lower-cost and preferred drugs at lower tiers that come with smaller out-of-pocket costs. But in the last few years, tiers have become more complex.
The tiers have grown from 2 to 3, 4 and 5. Plans now often distinguish between preferred generics and non-preferred generics, as well as preferred and non-preferred brand name drugs. Specialty medications, which according to one estimate cost 50 times more than a traditional brand-name drug, are found in the highest tiers. Patients usually pay a percentage of the cost of these expensive drugs, or co-insurance, in contrast to the set co-pays charged for medicines in lower tiers.
Read more at The Washington Post's Wonkblog: http://wapo.st/1x3T0pD