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TALKING POINTS SAMPLE LETTERS TOOLS FOR SUCCESS ISSUE BRIEFS TAKE ACTION POLICY UPDATES TIPS COLITIONS YOUR TOOLBOX SAMPLE LETTERS TIPS COALITIONS POLICY UPDATES ISSUE BRIEFS Tools for success TALKING POINTS By Katie Verb Specialty Tiers? We’re Here For You! s many of you know, tiering is a cost-sharing strategy Are you finding that your factor is being placed on a specialty A employed by insurers that places drugs into groups called tier within your prescription drug plan? Is your prescription “tiers” based on criteria determined by the insurer . A three- drug plan charging you a percentage of the cost for your fac- tiered drug formulary is traditionally used by many prescrip- tor? If so, this issue greatly affects you . On a national level, HFA tion drug plans . These tiers have fixed co-pays—for example, a is deeply involved with coalitions that advocate for HR 460, $10 monthly prescription refill for a generic drug . For drugs in The Patient’s Access to Treatment Act . HR 460 would limit the specialty tiers, however, instead of requiring flat rate co-pays, amount that can be charged for drugs placed on specialty tiers . insurers often require patients to pay a percentage of the cost However, many states are developing their own legislation to of a drug . This is known as co-insurance . Specialty tier co-insur- combat the issue . ance rates can vary from 20% to 50% or more . If you live in a state that has pending legislation regarding The most common drug tiering structure used by insurers the use of specialty tiers in prescription drug plans, HFA is categorizes drugs in the following way: here for you! We have posted tools, briefs, and talking points on our site to help you in your local fight against specialty tiers, Tier I and we are always just a phone call away to help you advocate Generic Drugs, typically the lowest, for your community! flat rate copay We want to know about the insurance Tier II challenges you face! Preferred Drugs, typically a medium, When you or a family member is denied coverage of a service flat rate copay or payment for a service, or learn that a provider is not covered by your insurance plan, you need a remedy FAST . The bleeding Tier III disorders community is fortunate that help is often available Non-Preferred Drugs, typically a higher, through a variety of organizations . These organizations can flat rate copay give you access to a limited supply of drugs, pay an insurance premium or out-of-pocket cost, or provide other needed assis- Tier IV or Tier V Specialty Tier tance . It is great help if you can get it! Unique, high cost drugs, patients charged However, it is important that your insurer hears about and un- coinsurance percentage of cost derstands the problem you experienced . Until an insurer knows a particular policy creates problems for individuals with bleed- Spring 2014 | Dateline Federation 3