Insurers Add 4th Tier to Prescription Pricing–Higher Costs for Patients–Attack of the Killer Algorithms Part 31 As That is What Calculates the Cost

Well we all know that once you leave tier one and two the costs go up tremendously so when does tier five appear one might ask? The one man quoted in the article states that his HIV drugs went from $80 a month to $450 a month. One state, New York has banned tier four plans.

There has to be some give and take between pharmaceutical companies and insurers and in this instance the insurers are not completely the bad guys as they usually are with risk analysis comparisons. In some areas there are no tier one and two drugs available and so tier three and four are the only ones available. Research and development is expensive for drug development as well, so where does all of this hit the road for consumers? We already know that in the US we pay more for our drugs than any other country and basically somewhat subsidize the lower costs that others get. It’s all about the math and profits here and granted a certain amount of profit is needed to keep companies alive but let’s face it the big huge profits of the pharmaceutical business can stay forever. BD

Thousands of patients in California and across the nation who take expensive prescription drugs every month for cancer, rheumatoid arthritis and other ailments are facing sticker shock at the pharmacy.

Until recently, most of these patients typically paid modest co-pays for the advanced drugs. But increasingly, Anthem Blue Cross, Aetna and other insurers are shifting more prescriptions to a new category requiring patients to shoulder a larger share of the drug's cost.
To help lower their costs, health plans are changing their approach to drug coverage, often expanding from a three-tier to a four-tier plan. The first tier would be generic drugs at a $10 co-payment, for instance, the second tier preferred brand-name drugs at a $30 co-pay, the next tier non-preferred brand-name drugs for $50, and the top tier would be dozens of specialty drugs costing patients 10% to 30% co-insurance or $150 co-pays.

http://www.latimes.com/business/la-fi-expensive-drugs-20120529,0,2965274.story