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Copayment Tier Definitions


Medications are assigned to one of four 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.

Tier 1 (Generic drugs)

  • Generic drugs
  • Features the lowest copayment

Tier 2 (Preferred brand-name drugs)

  • Preferred brand-name products based on safety, efficacy, and cost
  • Second lowest copayment

Tier 3 (Brand-name drugs)

  • Brand-name drugs for which alternatives are available in Tier 1 or Tier 2; or
  • Not used typically as a first line of treatment; or
  • Some brand-name drugs with a generic equivalent; or
  • Preferred specialty brand-name drugs
  • Higher copayment

Tier 4 (Specialty brand-name drugs)

  • Medications classified by BCBSNC as those which require special dosing or administration, are typically prescribed by a specialist and are more expensive than most medications
  • Highest copayment or coinsurance amount


    • This list was last updated on November 2009.
    Growth-Stimulating Drugs
    GENOTROPIN Somatropin injection
    INCRELEX Mecasermin injection
    OMNITROPE Somatropin injection
    SAIZEN Somatropin injection
    SEROSTIM Somatropin injection
    TEV-TROPIN Somatropin injection
    ZORBTIVE Somatropin injection
    Anti-Infectives
    DECLOMYCIN (brand only) Demeclocycline tablet
    NOXAFIL Posaconazole oral suspension
    VFEND Voriconazole tablet, oral susp
    Infertility
    BRAVELLE Urofollitropin injection
    CETROTIDE Cetrorelix acetate injection
    ENDOMETRIN Progesterone micronized insert
    FOLLISTIM Follitropin beta injection
    FOLLISTIM AQ Follitropin beta injection
    GANIRELIX ACETATE Ganirelix acetate injection
    GONAL-F Follitropin alfa injection
    GONAL-F RFF Follitropin alfa injection
    LUVERIS Lutropin alfa injection
    MENOPUR Menotropins injection
    NOVAREL (brand only Chorionic gonadotropin injection
    OVIDREL Choriogonadotropin alfa injection
    PREGNYL (brand only) Chorionic gonadotropin injection
    PROFASI (brand only) Chorionic gonadotropin injection
    REPRONEX Menotropins injection
    Rheumatoid Arthritis / Psoriasis / Crohn's Disease
    ARAVA (brand only) Leflunomide tablet
    CIMZIA Certolizumab pegol injection
    HUMIRA Adalimumab injection
    KINERET Anakinra injection
    SIMPONI Golimumab injection
    Hepatitis C
    REBETOL CAPSULE (brand only) Ribavirin capsule
    COPEGUS (brand only) Ribavirin tablet
    Anticoagulants
    ARIXTRA Fondaparinux injection
    FRAGMIN Dalteparin injection
    INNOHEP Tinzaparin injection
    Blood Modifiers
    EPOGEN Epoetin alfa injection
    LEUKINE Sargramostim injection
    MOZOBIL Plerixafor injection
    NEULASTA Pegfilgrastim injection
    PROCRIT Epoetin alfa injection
    Oncology
    AFINITOR Everolimus tablet
    FASLODEX Fulvestrant injection
    HYCAMTIN Topotecan capsule
    LUPRON (brand only) Leuprolide acetate injection
    TASIGNA Nilotinib capsule
    VEPESID (brand only) Etoposide capsule
    VOTRIENT Pazopanib tablet
    ZOLINZA Vorinostat capsule
    Antiemetics
    ANZEMET Dolasetron tablet
    KYTRIL (brand only) Granisetron tablet, oral solution
    SANCUSO Granisetron patch
    Fentanyl Transmucosal
    ACTIQ (brand only) Fentanyl lozenge
    FENTORA Fentanyl buccal tablet
    ONSOLIS Fentanyl buccal film
    Dermatology
    ACCUTANE (brand only) Isotretinoin capsule
    REGRANEX Becaplermin gel
    Miscellaneous
    ACTHAR H.P. Repository corticotropin injection
    ARCALYST Rilonacept injection
    D.H.E. 45 (brand only) Dihydroergotamine injection
    EXJADE Deferasirox tablets
    FORTEO Teriparatide injection
    KUVAN Sapropterin soluble tablet
    PROMACTA Eltrombopag olamine tablet
    RELISTOR Methylnaltrexone bromide injection
    REVIA (brand only) Naltrexone tablet
    SAMSCA Tolvaptan
    SOMATULINE DEPOT Lanreotide acetate injection
    SYNAREL Nafarelin acetate nasal solution
    THYROGEN Thyrotropin alfa injection
    XENAZINE Tetrabenazine tablet

If a member chooses a brand name drug when a generic equivalent is available, the member typically will be responsible for paying the difference between the cost of the generic drug and the brand name drug in addition to the higher tier copayment, unless the member’s physician specifically states that the brand name drug is necessary.