Prescription-Drug Plans' Use of Specialty Tiers Promotes Inequalities
For Immediate Release
August 10, 2011 | WASHINGTON D.C.
Prescription-Drug Plans’ Use of Specialty Tiers Promotes Inequalities
Issue Brief Questions Increased Use of Tiered Cost Sharing
In a just-released National Minority Quality Forum Issue Brief (Specialty Tiering: Unequal Treatment ), Gary Puckrein and Gretchen Wartman examine specialty tiering, which has become popular among insurers (public and private) as a benefit-management tool to limit their financial exposure by requiring beneficiaries to pay more for certain high-cost prescription drugs. The authors remind us that the Institute of Medicine cautioned in 2003: “Aspects of health systems—such as the ways in which systems are organized and financed, and the availability of services—may exert different effects on patient care, particularly for racial and ethnic minorities” (Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care [Washington, DC: National Academies Press, 2003], p. 8). Specialty tiering exerts different effects by design. It chips away at the risk-pooling effects of insurance by shifting a significant percentage of the cost of expensive medical treatments to beneficiaries, possibly forcing the less affluent to choose between paying for basic living expenses or taking their medications. Cost shifting without means testing compromises access to quality care and increases the potential for disparate and poor health-care outcomes among minority populations, the financially less able, beneficiaries with cancer or other complex diseases that require expensive medical therapies, and those whose biologies may cause them to metabolize drugs differently.
“We believe that this issue brief is quite timely,” explains Dr. Puckrein, who is president and chief executive officer of the National Minority Quality Forum. “The current economy not only calls for creativity and a willingness to find new answers for old problems, but also necessitates a steadfast commitment to the principle that the health and safety of all Americans is paramount. The temptation to quietly erect barriers to quality health care through specialty tiers and other forms of cost shifting that are insensitive to a beneficiary’s financial abilities must be resisted. Cost shifting will be dressed up as an easy and obvious solution, but insurers should have no role in picking winners and losers among those who depend upon them.”
The issue brief explores the important contribution that health insurance (public as well as private) has made to improvements in the quality of life and to longevity in this country. In this context, Dr. Puckrein and Ms. Wartman question the wisdom of specialty tiering and urge insurers to stop the practice..
About The Forum
The National Minority Quality Forum (NMQF) is a 501(c)(3) not-for-profit, non-partisan, independent research and education organization. The vision of NMQF is a health services research, delivery and financing system that provides quality and effective health services to the biodiverse American general population of the 21st century. NMQF helps assure that national and local quality improvement initiatives are informed by scientific evidence, and place a priority on the quality of care and patient outcomes in all populations.
Gretchen C. Wartman, VP Policy and Program
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