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Copayment Tier Definitions

Medications are assigned to one of four, five or six categories known as copayment or coinsurance tiers, based on drug usage, cost and clinical effectiveness. Our prescription drug search can show you which tier applies to a specific medication based on your benefits plan.

Copayment Definitions for the Four-Tier Formulary

Tier 1 - The prescription drug tier which consists of the lowest cost tier of prescriptions drugs, most are generic.

Tier 2 - The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and some brand-name prescription drugs.

Tier 3 - The prescription drug tier which consists of higher-cost prescription drugs, most are brand-name prescription drugs, and some are specialty drugs.

Tier 4 - The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs.

Copayment Definitions for the Five-Tier Formularies

Tier 1 - The prescription drug tier which consists of the lowest cost tier of prescription drugs, most are generic.

Tier 2 - The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and some brand name prescription drugs.

Tier 3 - The prescription drug tier which consists of high-cost prescription drugs, most are brand-name prescription drugs.

Tier 4 - The prescription drug tier which consists of the higher-cost prescription drugs, most are brand-name prescription drugs, and some specialty drugs.

Tier 5 - The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs.

Copayment Definitions for the Six-Tier Formularies

Tier 1 - The prescription drug tier which consists of the lowest cost tier of prescription drugs, most are generic.

Tier 2 - The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and some brand name prescription drugs.

Tier 3 - The prescription drug tier which consists of high-cost prescription drugs, most are brand-name prescription drugs.

Tier 4 - The prescription drug tier which consists of the higher-cost prescription drugs, most are brand-name prescription drugs, and some specialty drugs.

Tier 5 - The prescription drug tier which consists of some of the highest-cost prescription drugs, most are specialty drugs.

Tier 6 - The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs.