A cancer diagnosis is enough bad news for most people.

But for many with cancer, more bad news follows when anexpectedly high bill arrives for the specialty drugs prescribed to treatthe disease.

In a study released by the American Cancer Society, the bad newsis exactly that: Cancer patients couldn’t figure out, or didn’teven check, ahead of time to see whether and how much of thecost of specialty cancer drugs wascovered by their health plan.

Read: Exchanges moving more drugs to specialitytier

And all too often, their out-of-pocket requirements were wellbeyond what they had planned for.

The real shocker: Cancer drugs that had been considered more ofa garden variety and thus less expensive in the past fell intohigh-cost “tiers” established by some plans.

ACS studied plans in six states to get a handle on what folksmight be paying out-of-pocket for these medications.

Just about every one of the 22 drugs included in the study fellinto these tiers, including Gleevec (leukemia) and Herceptin (breast cancer), both of which have been available for sometime.

Even generics would be included in thehigh-cost tiers.

“That is new this year. We didn’t see generic drugs placed onthe highest tier in 2014,” said Kirsten Sloan, the group’s seniorpolicy director.

ACS said what’s going on is that insurers are requiring patientsto pay a percentage of the drugs included in the tiers, as opposedto paying a set, or flat fee, amount when they purchase theirdrugs.

That’s what driving up the out-of-pocket spending.

The report blasted such insurers for effectively steeringpatients toward drugs where insurers could reap a windfall insteadof helping patients find alternative drugs that, in some cases,have been shown to be more effective than the tiered options.

Predictably, pharmaceutical, and insurance plan advocatesattacked the study.

But the ACS stuck to its findings, calling on regulators to reinin such practices and to help consumers make better plan choices byrequiring insurers to be more transparent about the true cost ofcertain treatments and medications.

“Advocacy groups are telling consumers to be vigilant aboutpicking a plan, but consumers then find they don’t have all thetools they need,” Sloan said.