What do the different tiers mean?
Drugs on a formulary are typically grouped into tiers. The tier that your medication is in determines your portion of the drug cost. A typical drug benefit includes three or four tiers:
Tier 1 usually includes generic medications.
Tier 2 usually includes preferred brand-name medications.
Tier 3 usually includes non-preferred brand-name medications.
Tier 4 usually includes specialty and biosimilar medications (Three-tier programs do not have a unique tier for specialty medications)
A medication may be placed in tier 3 or 4 if it is new and not yet proven to be safe or effective, or there is a similar drug on a lower tier of the formulary that may provide you with the same benefit at a lower cost.
Note: If you have a federally qualified high-deductible health plan, you do not have a tiered drug benefit; your pharmacy and medical expenses are subject to your deductible and coinsurance. This section does not apply to you.
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