Issue Brief 7: Out-of-Pocket Costs and Specialty Medications

In recent years, there have been remarkable advances in drug development, including new treatments for certain cancers, autoimmune conditions, rare diseases and other life-threatening conditions.

New medications for these conditions are often very expensive, and for many patients who need specialty medications, there is no lower cost equivalent medication available.

This Issue Brief describes formulary tiers, explores the rationale for specialty drug tiers, and how out of pocket costs for specialty medications can reduce access to these drugs. The brief also examines the financial hardship that results from high OOP costs for specialty medications.