Prescription-Drug Plans' Use of Specialty Tiers Promotes Inequalities: Issue Brief Questions Increased Use of Tiered Cost Sharing

August 10, 2011

Prescription-Drug Plans’ Use of Specialty Tiers Promotes Inequalities

Issue Brief Questions Increased Use of Tiered Cost Sharing

WASHINGTON, DC: In a just-released National Minority Quality Forum Issue Brief (Specialty Tiering: Unequal Treatment http://www.nmqf.org/IB3SpecialtyTiersFinal.pdf), 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 National Minority Quality Forum

Founded as a nonprofit organization in 1998, the National Minority Quality Forum (http://www.nmqf.org) was established to strengthen national and local efforts to eliminate the disproportionate burden of premature death and preventable illness in racial and ethnic minorities and other special populations through the use of evidence-based, data-driven initiatives.