Specialty tiers: Benefit design considerations for commercial payors

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By Bruce S. Pyenson, Gabriela Dieguez, Rebecca L. Johnson | 16 October 2012

Today's specialty drugs are the product of major scientific achievements and are used by thousands of patients. The cost of these therapies can range from several hundred dollars to thousands of dollars. For people with health insurance, the high costs are typically split between the patient and the patient's prescription drug coverage or medical coverage. 

This report explores the prescription drug costs added to commercial plans by specialty drugs, how much individual out of pocket costs vary with different benefit designs, and how payors can reduce prescription drug costs without using specialty tiers. This study is intended to convey information about the relationship between benefit designs, cost to payers, and members' out-of-pocket costs for specialty drugs. Ultimately, there are methods to reduce plan costs without overly burdening patients, through the redesign of benefit structures to reduce the impact of specialty drugs. 

This report was commissioned by Pfizer, Inc. 

Authors

Healthcare