Recent Kaiser and PBMI employer surveys have shown that a growing number of companies are adopting formularies with specialty tiers — and the higher member out-of-pocket responsibility that comes with such tiers.
But Medicare continues to lead the way in this approach to tiering. An Avalere Health analysis of Medicare Part D drugs and how they are covered by prescription drug plans shows that the number of plans that offer formularies with five or more tiers will almost double from 2010, when about 30% offered this kind of benefit design, to 2012, when almost 60% will have this type of formulary.
In addition, Avalere shows that the average member coinsurance in the fifth tier this year is 27.1%. That percentage will rise to 32.2% in 2012.
Where does this leave members who take high-cost specialty therapies? What alternatives do plans have?