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?

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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.

  • 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.  

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