Specialty medications used to treat rare and costly medical conditions, are continuing to increase in cost to the state-sponsored health insurance plans every month. In fact, about 2% of our plan members and 1% of all prescriptions account for 40% of the total prescription drug costs. Because, in aggregate, the plans had been paying 99% of the overall cost of specialty medications the Insurance Committees (State, Local Education, and Local Government) voted in summer 2016 to institute a 10% coinsurance on specialty medications for the PPO options, with a minimum member out of pocket of $50 and a maximum of $150. The CDHP regular coinsurance applies, as it always has. This helps the plan to better share the expense of costly specialty medications with plan members. Also, the plan requires that any specialty medication only be filled for a 30-day supply (to eliminate waste) and that all specialty medications must be filled through a pharmacy in the CVS/caremark Specialty Network (though not necessarily CVS/caremark’s own specialty pharmacy). To find a specialty pharmacy, go to info.caremark.com/stateoftn and click on the “Specialty Pharmacy List” link in the Network Lists box.
My specialty prescription has gone way up in cost (even to $150). What is going on?
