Rep. Johnson to Medicare: Clarify why 'specialty tier' drug threshold remains $600

Congressman concerned seniors being priced out by the rising cost of life-saving prescriptions

WASHINGTON, D.C. – Rep. Hank Johnson (GA-04) sent a letter of inquiry to Centers for Medicare and Medicaid Services (CMS) May 11 concerning the onerous cost-sharing requirements that Medicare Part D prescription drug plans are increasingly imposing on seniors.

Using a system known as “specialty tiers” to classify high-cost drugs, Medicare forces recipients to pay up to 33 percent of a drug’s cost that exceeds $600, as opposed to charging seniors a fixed co-pay amount similar to those used for generic or preferred brand drugs.

Although the costs of all prescription drugs are rising, Medicare’s “specialty tier” threshold for high-cost medications remains $600 for the fifth year in a row. Congressman Johnson is concerned this threshold is being held to artificially low levels without explanation or transparency.

“The tier system can force seniors to spend thousands of dollars out of pocket for life-saving prescriptions,” said Johnson, who is a member of the House Seniors Task Force.

“My concern is that seniors are being priced out by this arbitrary threshold and it could in some cases force seniors to choose between medications and putting food on the table or paying bills.”

In the letter, Johnson requests CMS to explain why the specialty tier drug limit is frozen at $600, to clarify the process for the sake of transparency and to analyze the effect freezing the threshold at $600 will have on seniors.

Nineteen Congressional colleagues signed the letter, including Rep. John Conyers (MI-14), Rep. Mike Honda (CA-15) and Barney Frank (MA-04).

To read the letter, click here.

###