What are the Tiers for Prescription Drugs?
When a doctor gives you a prescription, it is important to understand what is covered. Normally, the best way to find out is by accessing your plan’s formulary. There, you can find a list of generic and brand-named medications approved by the FDA.
Prescription drugs usually have tiers, which are categorized by cost. Your cost-share, or copay, is usually determined by which tier your medication is in.
There are typically 3 or 4 tiers:
Tier 1: Generic drugs
These are usually the least expensive drug options, often generic drugs.
Tier 2: Low-Cost Brand name drugs & High-Cost Generic Drugs
These are higher priced generic medications and lower-priced brand-name medications.
Tier 3: High-Cost Brand name Drugs
Mainly Higher cost brand name drugs. Sometimes, there may be generic alternatives in Tier 1 or Tier 2.
Tier 4: Highest-Cost Prescription Drugs
Mostly Brand-named drugs and usually very expensive.
If you have any questions about which prescription is right for you, always speak with your doctor.
If you have any questions about health insurance, always speak with a licensed insurance professional.
Sources:
What is a Prescription Drug List? | UnitedHealthcare (uhc.com)
