REVISING SPECIALTY TIERS: PROTECTING MEDICARE PART D BENEFICIARIES FROM BURDENSOME COST SHIFTING

>> Download the Report Here [PDF]

THE MAPRx COALITION RELEASES REPORT ON WAYS TO IMPROVE PATIENT PRESCRIPTION DRUG ACCESS, AS LAWMAKERS TAKE STEPS TO TACKLE ISSUE OF SPECIALTY TIERS IN MEDICARE PART D

WASHINGTON, D.C., July 25, 2013 – The MAPRx Coalition (MAPRx) today released, “Revising Specialty Tiers: Protecting Medicare Part D Beneficiaries from Burdensome Cost Shifting,” a report highlighting flaws in the specialty tier policy in Medicare Part D.  The report is being released at the same time as U.S. Rep. Hank Johnson (D-GA) reintroduces H.R. 2827, The Part D Beneficiary Appeals Fairness Act, today on the House floor.  Senate Aging Committee Chairman Bill Nelson (D-FL) introduced the bill in the Senate as S. 1365.

Rep. Johnson is joined by cosponsors Rep. Walter Jones (R-NC) and Rep. David McKinley (R-WV).  Senate Aging Committee Ranking Member Sen. Susan Collins (R-ME) is the lead cosponsor of Nelson’s bill.

“These members are long-time champions of Medicare beneficiaries who live with severe chronic conditions, and we are very grateful for their continued support and leadership on this issue,” said Sandra Raymond, President and CEO of the Lupus Foundation of America and leader of the MAPRx Coalition. “The bill is a great first step at addressing the unfair and discriminatory practice of specialty tiering in Part D.”

In the report, MAPRx underlines key imperfections in the specialty tier policy of Medicare Part D:

• Although Medicare Part D has helped many beneficiaries manage their drug expenses, there is still a subset of Part D enrollees who have debilitating and life threatening chronic conditions who continue to pay extremely high drug prices because their medication is placed on a “specialty tier” by their Medicare prescription drug plan.
• Unlike lower cost medications, these medications are subject to significant coinsurance, leaving patients to pay thousands of dollars out-of-pocket. For many beneficiaries, the result is that they are denied access to the most appropriate medication due to the fact that it is financially out of reach.
• The specialty tier policy creates an undue burden on one of the most vulnerable populations – seniors and people affected by life-threatening diseases.

“The National Psoriasis Foundation supports the introduction of this legislation, which will provide an additional level of protection for Medicare beneficiaries with chronic conditions, like psoriasis and psoriatic arthritis,” said Leah Howard, director of government relations and advocacy at the National Psoriasis Foundation and MAPRx Coalition member. “Specialty tiers for expensive medications, such as biologic drugs used to treat psoriasis and psoriatic arthritis, require individuals to pay high copayments and can restrict access to needed medications. Without access to prescribed medications, these patients risk health complications and, sometimes, even permanent disability.”

MAPRx urges Congress to pass the Part D Beneficiary Appeals Fairness Act.

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MAPRx is a coalition of beneficiary, patient advocacy, family caregiver and health professional organizations committed to safeguarding the well-being of patients with chronic diseases and disabilities under Medicare Prescription Drug Coverage. MAPRx member organizations collaborate with national and state policymakers to ensure that beneficiaries have the access to the medication therapies they need and deserve. Learn more at www.maprx.info.