Across the country, many health plans have been moving towards the use of new “specialty tiers” for higher-priced drugs. These abandon the traditional three-tier $10/$25/$50 co-pay system in favor of a fourth tier which instead is based on a fixed percentage of the actual drug cost (usually 20% – 33%). Now, this would be all fine and dandy if we were only talking about a $12 dose of delicious pink Amoxicilin. But, for many of these higher-cost, and often life-sustaining, drugs, this fixed percentage can often add up to as much as $600 – $800 per month.
With the new law, these “specialty tiers” will be prohibited in private plans operating in NY effective October 31, 2010. Special thanks to HCFANY members New Yorkers for Accessible Health Coverage and the MS Society for all of their hard work on getting this bill passed and signed.
Read the summary or the text of the “Tier IV” bill here: A.8278B/S.5000B