Share your story about Specialty Tier Medications

Family Voices Indiana shares the following opportunity for you to share your voice……

In recent years, health care insurers have developed Specialty Tiers, otherwise known as Tier IV, V, and VI, a new classification of specialty drugs that requires health insurance beneficiaries to pay 20 - 35% of the cost of the drug. This approach is markedly different from traditional drug tiers with transparent and fixed co-payments, ranging from a Tier I generic at $10, to a Tier II preferred brand at $30, and a Tier III brand name drug at $50.   Most commonly health insurance companies use this new classification for infused or injected drugs prescribed and administered to patients with acute and chronic diseases, such as rheumatoid arthritis, multiple sclerosis (MS), AIDS/HIV, psoriasis, Crohn’s disease, immune disorders, hepatitis, anemia, and certain types of cancer.  

The Health Finance Committee will be looking at this issue next week.

We have been asked to gather family stories ASAP about how this impacts, or could impact, you or your loved one.  

If you are willing to share your story, please include the following information as well as contact info: email or phone #

   Name, age, town of residence

-         What are the specific conditions/diseases that the patient(s) have?

-         How many medications does each patient take?

-         How much do those medications cost (out-of-pocket) each month per patient? Could the costs increase without legislation to address the problem?

-         Do you pay a co-pay or a co-insurance?

-         Have the medications ever unexpectedly increased without warning, or with little warning. i.e. three years ago they went from $200/month to $600/month

-         Has the patient ever had to forgo any medication because of cost?

Sample paragraph: “One of these affected patients is Jane Doe. A Muncie resident, Jane lives with numerous chronic conditions such as MS, Reflex Sympathic Dystrophy, gastroparesis, high blood pressure, and several others, requiring her to take at least nine different medications.  Jane pays $300 in co-pays and for one medication, her insurance only pays for one tablet per day and she needs to take three tablets per day to control nausea and to be able to eat.  Jane takes some of her medications every other day to stretch them out, and one MS drug she goes without because she cannot afford the co-pay.”

The email address for families to send the story to is: advocatestories@gmail.com

Your voice matters.