Specialty Pharmacy
We are looking over our plan set up in regards to our pharmacy plans. We are currently on three tiers but looking to go to 4 or 5 tiers. Has anyone done this? What was the outcome?
4 replies
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Jarlyn, we work with a lot of group plans, and many have transitioned over to 4 or 5, or even 6 tiers due to the skyrocketing costs of specialty medications. I have not had any negative experiences in making this transition, but you do need to handle the communications well. Feel free to call me with questions. Ted Zalla 513-703-8837
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Be sure to look at the demographics of your population on specialty meds, especially from an income perspective, and the potential financial hurdle you may create by adding a tier(s).
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Thanks! We have decided to forgo this option at this time.
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For several years, we only had 2 options - Employee or Employee +any dependent(s). We changed to a 4-tier last year and very well received. We charge the same for couples or employee with child(ren). Everyone starts at a Basic Rate (45% of premium for singles and 50% of premium for couples, children, or families). If employee (and spouse, if on plan) go to their provider and bring back a signed document that they had a preventive care physical (this is not result-based - just see your dr at least once per year) -earns a 10% reduction. If employee (and spouse, if on plan) are non-tobacco user or complete a tobacco cessation class - another 10% reduction. Therefore, single who sees dr and non-tobacco user pays 25% of premium and every other plan would pay 30% of premium.