Part D Plans Want A Preferred Specialty Tier, But Not The Limit To Generics And Biosimilars
Payers say Part D plans should have flexibility in determining which drugs to place on a preferred specialty tier, while manufacturers oppose the notion of a second specialty tier altogether.
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Use of preferred and non-preferred specialty formulary tiers will be allowed but preferred tiers are not necessarily limited to generics and biosimilars and coinsurance for non-preferred specialty drugs cannot exceed 33%.
But cost sharing for non-preferred specialty drugs cannot exceed the current 25%-33% coinsurance currently allowed for the specialty tier, the Centers for Medicare and Medicaid Services says in a proposed rule.
US legislation attempts to address manufacturer, pharmacy benefit manager impact on patient costs in addition to health plan benefit designs. Critics suggest it’s too easy on manufacturers but that may help its chances with Republicans.