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Specialty Tier Pharmacy Benefit Designs in Commercial Insurance Policies: Issues and Considerations
State Health Reform Assistance Network, a program of the Robert Wood Johnson Foundation Link to more items from this source
Aug. 19, 2014
8 pages. "The one design that has survived and emerged as the most common approach [to moderating the costs of providing prescription drug coverage] is the tiering of benefits, or benefit designs that assign covered prescription drugs to a 'tier' based on cost-sharing and other requirements, like preauthorization.... [F]or those in need of drugs on the higher tiers with the most cost-sharing, three important issues have emerged for regulators to consider: [1] the affordability of prescription drug therapies for those who need them most; [2] the adherence challenges that result from loss of affordability; and [3] the potential for tiered pharmacy benefit designs to violate the anti-discrimination provisions of the ACA."

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