Replies to post #197063 on Amarin Corp Plc (AMRN)

[sts66]

Tier 1 preferred generic
Tier 2 generic
Tier 3 preferred brand

That's Silverscrips I assume? Explains the pricing and copay questions I had if yes - and to be honest, I thought I hadn't seen tiers like that before - but I'll be damned, went back and looked up my old Aetna and current Humana formularies, and they use the same tier definitions - where I came up with "T2 is preferred name brand" I have no idea, but clearly I've been using the wrong tier that V should be on for quite some time - also makes me wonder why JT said "over 90% of adult lives on Medicare Part D covered by insurance predominantly tier 2" when V appears to be ineligible for T2 on a Part D plan as it's not generic.

Ok, had to look this up - Medicare.gov says T2 "can be" preferred brand name, but we now know three large Part D provides, Aetna, Humana, and Silverscrips, do not use these tier definitions:


https://www.medicare.gov/drug-coverage-part-d/what-drug-plans-cover

To lower costs, many plans place drugs into different “Tiers” on their formularies. Each plan can divide its tiers in different ways. Each tier costs a different amount. Generally, a drug in a lower tier will cost you less than a drug in a higher tier.

Here's an example of a plan's tiers (your plan’s tiers may be different):

Tier 1—lowest Copayment : most generic prescription drugs
Tier 2—medium copayment: preferred, brand-name prescription drugs
Tier 3—higher copayment: non-preferred, brand-name prescription drugs
Specialty tier—highest copayment: very high cost prescription drugs

In some cases, if your drug is in a higher (more expensive) tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you can file an Exception and ask your plan for a lower copayment.

Remember, this is only an example—your plan's tiers may be different.

Note: Medicare.com, which is not government sponsored, also uses the same tier definitions as Medicare.gov - no wonder I was confused. And sheesh, BCBS of Michigan uses SIX tiers!

https://www.bcbsm.com/medicare/help/understanding-plans/pharmacy-prescription-drugs/tiers.html

Tier 6 Select care. These are generic drugs used to treat diabetes and high cholesterol For most plans, you'll pay $0-$5 for drugs in this tier..

So JT's "T2" statement is even more effed up now from where I sit - and it's not an issue that has sparked arguments here, what the copay is if covered and whether it's affordable, it's the tier he claims V is on for 90% of Part D plans - I'd be willing to bet the majority of plans use the tier defs you provided, meaning V is T3 (or T4) if on formulary.

Had to look *that* up too - UnitedHealth, Humana, and CVS Health cover 55% of Part D enrollees in 2018:

https://www.kff.org/medicare/issue-brief/medicare-part-d-in-2018-the-latest-on-enrollment-premiums-and-cost-sharing/

All three of those Part D plans (Silverscrips is a subsidiary of CVS Health) use T3 as preferred brand name, so this debate is over - JT's statement is plain wrong, end of story.