May 18, 2011 
Just this week, I’ve seen two things about creating more formulary tiers. One was talking about splitting generics into two tiers. The other mentioned that CMS said a sixth tier could be used in certain circumstances. It sounds like this could get out of control.
Will we end up with something like this:
- Low-cost generics (i.e., $4)
- Generics
- Formulary brands (non-specialty)
- Non-formulary brands (non-specialty)
- Lifestyle drugs
- Specialty biosimilars
- Formulary specialty drugs
- Non-formulary specialty drugs
It seems reasonable that we could end up with 8 tiers! That is a patient nightmare. It’s difficult enough to understand today. Maybe, I’ll finally become a believer in a percentage copay model with just two or three tiers of cost share with maximums.
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