Medicare expands tier pricing system for MS meds: Medicare's drug benefit, expanding on a practice now in limited use in the private sector, requires patients to pay larger co-payments for expensive treatments, including some drugs for MS.

While most working-age adults have insurance with two or three different "tiers" corresponding to how much they pay at the pharmacy for certain drugs — with generics the cheapest and brand-name drugs more — about 40% of the Medicare plans have four tiers, according to the analysis by Avalere Health, a for-profit research firm in Washington that did an analysis of the drugs earmarked for higher payments by patients. Fourteen percent have five tiers.

In comparison, 4% of workers with health insurance through their jobs have a fourth tier, according to a nationwide survey by the non-profit Kaiser Family Foundation.

In that fourth tier — where Medicare patients will most commonly pay 25% to 33% of the cost of the drug rather than a flat dollar amount — are such expensive treatments as Remicade and Enbrel for rheumatoid arthritis, Procrit and Aranesp for anemia and Copaxone and Betaseron for MS