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.
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The authors add that cost shifting without means testing (consideration of whether a beneficiary is eligible for additional financial assistance) compromises access to quality care and increases the potential for disparate and poor health-care outcomes among minority populations, those with financial troubles, beneficiaries with 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," said Puckrein, 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."
Puckrein and Wartman state that both public and private health insurance have made significant improvements to the lives of beneficiaries, and therefore urge insurers to stop specialty tiering.
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