Specialty tiering in the prescription drug market is causing some less affluent and minority beneficiaries to make difficult care decisions, according to a National Minority Quality Forum Issue Brief by Gary Puckrein and Gretchen Wartman.

The brief examines specialty tiering, which has become popular among both public and private insurers as a benefit-management tool to control costs. Tiering requires beneficiaries to pay more for certain high-cost prescription drugs. In 2003, the Institute of Medicine said, "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" 

Specialty tiering chips away at the risk-pooling effects of insurance by shifting a significant percentage of the cost of expensive treatments to beneficiaries. According to Puckrein and Wartman, this could possibly force the less affluent to choose between paying for basic living expenses or taking their medications.