Under your insurance plan, the prescription medicines available to you are split into tiers, which then determine your cost. Medicines are typically placed into 1 of 5 tiers—from Tier 1 (generics) to Tier 5 (highest-cost medicines)—depending on their strength, type or purpose.
Your medicines may be split up into 3-tier, 4-tier or 5-tier groupings according to your insurance plan. Below you will find how your medicines could be divided depending on how many tiers your prescription drug plan has.
3-tier plan:
Covered prescription drugs are assigned to 1 of 3 different levels with corresponding copayment or coinsurance amounts. The levels are organized as follows:
- Level or Tier 1: Generic drugs, which could be low-cost preferred generics or general preferred generics
- Level or Tier 2: Brand-name drugs, including preferred and nonpreferred options
- Level or Tier 3: Highest-cost drugs
4-tier plan:
Covered prescription drugs are assigned to 1 of 4 different levels with corresponding copayment or coinsurance amounts. The levels are organized as follows:
- Level or Tier 1: Low-cost generic and brand-name drugs
- Level or Tier 2: Higher-cost generic and brand-name drugs
- Level or Tier 3: High-cost, mostly brand-name drugs that may have generic or brand-name alternatives in Levels 1 or 2
- Level or Tier 4: Highest-cost, mostly brand-name drugs
5-tier plan:
Covered prescription drugs are assigned to 1 of 5 different levels with corresponding copayment or coinsurance amounts. The levels are organized as follows:
- Level or Tier 1: Preferred, low-cost generic drugs
- Level or Tier 2: Nonpreferred and low-cost generic drugs
- Level or Tier 3: Preferred brand-name and some higher-cost generic drugs
- Level or Tier 4: Nonpreferred brand-name drugs and some nonpreferred, highest-cost generic drugs
- Level or Tier 5: Highest-cost drugs including most specialty medications
