About

Insurance companies have divided medications and treatments into 4 main insurance tiers, the top and most expensive tier is known as the specialty tier. Drugs placed in the specialty tier are the most innovative, expensive, and most essential to life. With drugs in the specialty tier costing patients hundreds to thousands of dollars each month, patients with life threatening diseases such as cancer, arthritis, and multiple sclerosis struggle to afford the medication they need to keep them alive.

Specialty Tier Facts

57 million Americans depend on specialty drugs.
Drugs in the specialty tier provide treatment for our nation’s most vulnerable patient populations.
Specialty drugs are typically expensive treatments that require special handling or administration.
Example Diseases in the specialty tier include hemophilia, Chrohn’s Disease, Hepatitis C, HIV/AIDS and many forms of cancer.
Specialty drugs increased in price by 19.6% in 2010, versus the 1.4% increase for traditional drugs.
Specialty drug prices are expected to increase 27.5% by 2013.

Key Terms

Specialty tiers: most expensive tier, includes unique drugs/ treatments that most commonly treat serious/life threatening diseases. Also known as tier 4
Insurance tiers: divides medical drugs and treatments by price
Co-payment/co-pay: the flat amount you pay at the time of medical or medication. These fees are established up front and often printed on your health insurance card
Co-pay card: card given to you by your physician that you give to your pharmacist to reduce cost of medical drugs