ࡱ> =?<q` bjbjqPqP 4:: ::::V 1!6nnnnnI I I  $g#h%  I I nn    nn    nb ܟ:  !01!& "&(T&I !  |7 fI I I I I I 1! d:: Specialty Tiers: What Do They Mean to Georgia? In recent years, health plans have developed Specialty Tiers, otherwise known as Tier IV and V, whereby a significant portion of the cost of more expensive medications fall to the patient. This is markedly different from traditional tiers, with transparent, fixed co-payments, ranging from a Tier I generic at $10, to a Tier II preferred brand at $30, and a Tier III at $50. With Specialty Tiers, the consumer pays 20-35% of the cost of the medication. Medicines relegated to the Specialty Tier often treat acute and chronic disease that require intensive medical services, such as cancer, rheumatoid arthritis, multiple sclerosis (MS), Lupus, AIDS/HIV, psoriasis, Crohns disease, immune disorders, hepatitis, and anemia. The medications are often injected or infused, and administered by specialists in an office based setting. While these diseases afflict a small percentage of Georgians today, the very idea of Specialty Tiers appears to be discrimination, based on a disease state diagnosis, alone. Unfortunately, because of this benefit design, these newer, life-saving, medicines become financially out of reach for patients. This leads to non-compliance with their prescribed course of treatment, forcing patients to choose between medication and every day essentials. A recent study published jointly in the Journal of Oncology Practice (JOP) and American Journal of Managed Care (AJMC) showed that ten percent of cancer patients failed to fill their initial prescriptions for oral anti-cancer drugs, and for those who faced an out of pocket cost of over $500, one in four failed to fill the prescription. To put this in perspective, for a patient with MS, the average cost of therapy is approximately $2,200 per month. With patients responsible for 20-35% of the cost of the medicine, this out of pocket expense can be nearly $1,000 per month, for this single medication. Significance for Georgia In Georgia, almost 10% of prescriptions filled today are already in a Specialty Tier This is a growing practice in the commercial payer market, and this predatory practice puts Georgias citizens in harms way by putting needed medication financially out of reach for those that need it most Georgia has an opportunity to follow 19 other states, such as New York, Nebraska, California and others that are moving forward with legislation to support transparency of prescription coverage protecting patients full access to Specialty Tier drugs without financial devastation We ask for your help in identifying a solution to protect Georgians from this discriminatory cost shifting Specialty Tiers Coalition of Georgia ./01CO^p  ! 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