Consumers are largely unaware of the potentially high out-of-pocket costs associated with medications placed on specialty tiers by their prescription drug plans, according to a study conducted by NERA Special Consultant Dr. Eugene P. Ericksen and Senior Consultant Melissa Pittaoulis and commissioned by Pfizer. Specialty tiers are typically a fourth formulary category that includes higher-cost, brand name medications and often include medications used to treat conditions like cancer, multiple sclerosis, rheumatoid arthritis, HIV/AIDS, and lupus. The survey results described in this NERA paper indicate that a substantial percentage of Medicare Part D beneficiaries are uninformed about the out-of-pocket costs associated with specialty tier drugs. Many survey respondents were unaware that Part D insurance plans charge differently for expensive medicines used to treat complex, chronic diseases. Half of the survey respondents mistakenly believed their plan would require them to pay a co-pay rather than coinsurance for a drug on the specialty tier. Respondents also underestimated the amounts they would have to pay out of pocket for specialty tier drugs, including those used to treat rheumatoid arthritis and multiple sclerosis. The findings suggest that most beneficiaries are unlikely to anticipate the financial impact of being prescribed a drug on a specialty tier.