Part D plans embrace specialty drug tiers














Medical and pharmacy directors at Medicare Part D plans seem more inclined to create a separate specialty drug tier in their formulary design than their commercial counterparts.

Novartis’s Facts, Figures, & Forecasts, 2008–2009, reports that directors were asked to segment their enrollment by tiered copayment design options. Three fourths of the Medicare Advantage-Part D (MA-PDs) plans and stand-alone prescription drug plans (PDPs) had created a specialty tier in 2007, had introduced a specialty tier in 2008, or were planning to introduce a specialty tier in 2009.

Only 43 percent of commercial health plans reported having specialty tiers during that time.

Also reported were the types of drugs covered in the specialty drug tier. Most injectables were covered. Fewer plans covered oral oncologic agents and other oral agents on a specialty tier.

A number of these plans also designated drugs for the specialty tier based on member-cost threshold. Drugs with member costs starting as low as $500 per prescription, per month, or per claim were put on the specialty tier. A $600 member-cost threshold was most frequently reported by these plans.

The most common copayments for specialty tiers ranged between $25 and $250.

Source: Novartis Pharmacy Benefit Report. Facts, Figures, & Forecasts, 2008-2009.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

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