New York State Senators Tom Duane and Andrew Valesky have partnered to prohibit insurance carriers from charging an extra surcharge on co-pays for the most expensive medications and treatments, like factor concentrate. The bill which is still being reviewed at the committee level instructs the New York State Commissioner of Insurance to ignore health insurance policies that use the Tier IV pricing model in their policies.
Here is generally how tiered pricing works:
Tier I is the lowest co-payment option and typically includes prescriptions for generic medications.
Tier II, the middle co-payment option, may apply if no generic medication is available for treatment and/or your physician instead prescribes brand name medications covered by the insurer.
Tier III co-payment prices apply if and when you or your physician choose a drug that may be substituted with a generic brand and is not included on your insurers’ preferred drug list.
Tier IV would make people pay a percentage of the total retail cost of certain high-priced medications, a cost many suffering from illnesses say they cannot afford.
Already hard pressed to pay providers, this shift would significantly escalate costs to community members. This legislation pending in New York is critical. We salute Senators Duane and Valesky for their attention to this erstwhile effort.