by Amanda Conschafter, blog editor
Americans who begin 2015 with a new health care plan may soon discover the hidden costs of an insurance payment structure known as specialty tiers. In a newly released white board video, AfPA explains what specialty tiers are – and what they mean for both patients’ pocketbooks and their health.
As “The Cost of Specialty Tiers” explains:
- Specialty tier structures organize prescription medications in a hierarchical structure, placing more expensive advanced medications in a “specialty”
- Health plans require patients to pay a proportion of the specialty tier medication’s cost, known as co-insurance, instead of a flat payment, known as a co-payment.
- Patients who can’t afford to pay hundreds or thousands of dollars out of pocket for their medications’ co-insurance stop taking them. Nonadherence can lead to severe medical consequences, unexpected hospitalizations and higher medical costs in the long term.
Learn more about how health plan specialty tier structures work, and the proposals for making advanced medications more accessible. Watch AfPA’s “The Cost of Specialty Tiers” to learn more.