The The New York Times has an interesting piece this morning on "Tiered" pricing for pharmaceutical drugs. "Tiers" are, in essence, the practice of covering different pharmaceuticals at different rates. So a generic statin might be covered at 100 percent (Tier One) and you don't pay a penny to take it while an experimental cancer drug might force you to lay down thousands of dollars. The article focuses on Tier Four, where patients are paying a huge amount in order to access certain high cost drugs. The problem is that the article never tells us how Tier Four is decided. The article vaguely implies that Tier Four is simply composed of costly drugs that insurers are dumping on patients. My understanding of the situation is that Tier Four is actually composed of largely experimental and unproven treatments that don't seem to offer benefits in line with their cost. If it's the former, then this really is, as the article seems to suggest, a cruel and crazed practice. If it's the latter, then it's exactly what we need to be doing. And the question isn't academic: Tiering drugs have actually brought pharmaceutical costs way down in recent years, and can be a step towards the sort of smart cost sharing that liberals should embrace. The problem comes if the Tiering is being done without evidence, as a pure money-saving, rather than value-driven, effort. That's the salient question here. Sadly, the Times doesn't really address it.
