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Supervisors Hear That Specialty Tiers Are Pricing Patients Out of Life-Saving Drugs
Summary
At a March 25 Budget & Finance Committee hearing, city health officials, advocates and insurers discussed insurers classifying HIV, hepatitis C and other medications as "specialty" and the resulting coinsurance that can reach hundreds of dollars a month, potentially blocking access and undermining San Francisco's HIV strategy. Speakers urged state and federal reforms and greater formulary transparency.
Supervisors gathered March 25 to examine a growing trend in which insurers place high-cost medicines into a "specialty" tier that shifts patients from fixed copays to coinsurance, sometimes hundreds of dollars a month, and can make essential treatments unaffordable.
"Reclassifying a drug as, quote unquote, specialty means that instead of a patient paying a typical monthly copay, they must pay a significant percentage of the drug's cost, which can often mean a monthly coinsurance payment of $600 or a thousand dollars or more," Supervisor Scott Wiener said, opening the committee's oversight hearing.
Colleen Chavla of the Department of Public Health told the committee there is no single technical definition of "specialty"; plans often use it for drugs that require special handling or administration but increasingly apply the label to medicines priced above an informal threshold (often around $600 a month). Chavla cited Covered California analyses showing that some plans put large shares of HIV and…
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