| 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)
- FDA-approved versions of brand-name medications
- Features the lowest copayment
Tier 2 (Preferred brand drugs)
- Brand-name drugs that meet the needs of most patients
- Second lowest copayment
Tier 3 (Non-preferred brand drugs)
- Brand-name drugs without a generic version, but have therapeutic alternatives in Tier 2
- Not used typically as a first line of treatment
- Some brand-name drugs with a generic equivalent
- Higher copayment
Tier 4 (Specialty drugs)
- Medications classified by BCBSNC as those which require special dosing or administering, are typically prescribed by a specialist and are more expensive than most medications
- Highest copayment or coinsurance amount
This list was last updated on 8/1/07.
| Growth Hormones |
| GENOTROPIN |
Somatropin injection |
| PROTROPIN |
Somatrem injection |
| ZORBTIVE |
Somatropin injection |
| SAIZEN |
Somatropin injection |
| SEROSTIM |
Somatropin injection |
| Anti-Infectives |
| CYTOVENE (brand only) |
Ganciclovir capsule |
| DECLOMYCIN (brand only) |
Demeclocycline tablet |
| NOXAFIL |
Posaconazole oral suspension |
| VFEND |
Voriconazole tablet, oral susp |
| Infertility |
| REPRONEX |
Menotropins injection |
| OVIDREL |
Choriogonadotropin alfa injection |
| PERGONAL |
Menotropins injection |
| PREGNYL (brand only) |
Chorionic gonadotropin injection |
| NOVAREL (brand only |
Chorionic gonadotropin injection |
| PROFASI (brand only) |
Chorionic gonadotropin injection |
| LUVERIS |
Lutropin alfa injection |
| MENOPUR |
Menotropins injection |
| GANIRELIX ACETATE |
Ganirelix acetate injection |
| GONAL-F |
Follitropin alfa injection |
| GONAL-F RFF |
Follitropin alfa injection |
| BRAVELLE |
Urofollitropin injection |
| CETROTIDE |
Cetrotide injection |
| FERTINEX |
Urofollitropin injection |
| FOLLISTIM |
Follitropin beta injection |
| FOLLISTIM AQ |
Follitropin beta injection |
| FOLLISTIM/ANTAGON |
Follitropin beta/ganirelix acetate |
| Rheumatoid Arthritis / Psoriasis |
| ARAVA (brand only) |
Leflunomide tablet |
| KINERET |
Anakinra injection |
| HUMIRA |
Adalimumab injection |
| RAPTIVA |
Efalizumab injection |
| Hepatitis C |
| REBETOL CAPSULE (brand only) |
Ribavirin capsule |
| REBETRON 1000 |
Interferon alfa-2b/ribavirin |
| REBETRON 1200 |
Interferon alfa-2b/ribavirin |
| REBETRON 600 |
Interferon alfa-2b/ribavirin |
| COPEGUS (brand only) |
Ribavirin tablet |
| ROFERON-A |
Interferon alfa-2a |
| Anticoagulants |
| ARIXTRA |
Fondaparinux injection |
| FRAGMIN |
Dalteparin injection |
| INNOHEP |
Tinzaparin injection |
| Blood Modifiers |
| EPOGEN |
Epoetin alfa injection |
| PROCRIT |
Epoetin alfa injection |
| LEUKINE |
Sargramostim injection |
| NEULASTA |
Pegfilgrastim injection |
| Oncology |
| FASLODEX |
Fulvestrant injection |
| LUPRON (brand only) |
Leuprolide acetate injection |
| NEXAVAR |
Sorafenib tosylate tablet |
| REVLIMID |
Lenalidomide capsule |
| VEPESID (brand only) |
Etoposide capsule |
| SUTENT |
Sunitinib Malate capsule |
| ZOLINZA |
Vorinostat capsule |
| Antiemetics |
| ANZEMET |
Dolasetron tablet |
| CESAMET |
Nabilone capsule |
| KYTRIL |
Granisetron tablet, oral solution |
| Dermatology |
| ACCUTANE (brand only) |
Isotretinoin capsule |
| REGRANEX |
Becaplermin gel |
| Miscellaneous |
| ACTHAR H.P. |
Repository corticotropin injection |
| ACTIQ (brand only) |
Fentanyl lozenge |
| D.H.E. 45 (brand only) |
Dihydroergotamine injection |
| EXJADE |
Deferasirox tablets |
| FENTORA |
Fentanyl buccal tablet |
| FORTEO |
Teriparatide injection |
| INCRELEX |
Mecasermin injection |
| IPLEX |
Mecasermin rinfabate injection |
| LETAIRIS |
Ambrisentan tablet |
| REVIA (brand only) |
Naltrexone tablet |
| SYNAREL |
Nafarelin acetate nasal solution |
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