Prescription drug tiers.
In plain English
Prescription drug tiers are the cost levels a plan sorts covered drugs into, where lower tiers cost you less and higher tiers cost you more. A typical plan has several tiers, running from generic drugs at the bottom to preferred brand-name drugs, then non-preferred brands, and finally specialty drugs at the top. Your share of the cost (a flat copay or a percentage) is set by the tier, not by the drug's sticker price. Plans decide which tier each drug lands on, and they can move a drug to a different tier when the formulary updates.
01Why it matters
Two drugs that treat the same condition can sit on different tiers, so asking your doctor whether a lower-tier option exists can cut your cost without changing your treatment.
02The math, step by step
Imagine a plan with four tiers. A generic version of your blood pressure pill sits on tier 1 with a small flat copay. The brand-name version of the same medicine sits on tier 3, where you might pay several times more. Same condition, same active ingredient, very different price, decided entirely by the tier.
03What this is NOT
Tiers set what you pay per drug once coverage kicks in. The deductible is the amount you pay first, before the plan pays anything. Some plans apply the deductible only to higher tiers, so generics may be cheap from day one.
04Receipts
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