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Copayment Tier Definitions

Medications are assigned to one of four or five 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 Enhanced 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 prescripton drug tier which consists of the highest-cost prescription drugs, most are specialty drugs.

Copayment Definitions for the Five-Tier Basic and Five-Tier Enhanced 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.