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How Can We Prevent Adverse Tiering?

Feb 18, 2015 | | Corporate Governance, Definitions, Drug policy, Health Law, Law, Pharmaceuticals | No Comments

One of the Affordable Care Act’s main goals was to eliminate discrimination on the basis of preexisting conditions by requiring that all patients be insured and by instituting new age-adjusted community ratings for premiums. Yet, evidence suggests that insurers still discriminate by placing all medications that treat certain disorders, such as HIV, in the highest cost-sharing tiers making treatment unaffordable—a practice referred to as “adverse tiering.” According to a recent article from the New England Journal of Medicine, insurers across the country are utilizing adverse tiering to place increased and unexpected financial strain on patients with chronic conditions. Several policies can be put into place to prevent adverse tiering, including the establishment of protected conditions in drug formularies and requiring marketplace plans to offer drug benefits that meet a given actuarial value. For more information, read here.

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