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.
If not reversed by the Biden Administration, demo program that puts plans at increased risk in catastrophic phase would also enhance negotiating leverage for drugs in the protected classes.