How do drug tiers work?
Who is this for?
If you're wondering how much your prescription drugs will cost you, this information will give you some background on how we price medications.
Do you ever feel like predicting the weather would be easier than predicting medical costs? You’re not alone. The good news is that when it comes to prescription drugs, drug tiers can help you make an educated guess about what you’ll pay.
Drug tiers are how we divide prescription drugs into different levels of cost. Drugs in Tier 1 will be your cheapest options. Drugs in Tier 5 will be the most expensive.
What does each drug tier mean?
Here’s a breakdown of each tier. The cost information is for a one-month supply of drugs from an in-network pharmacy.
|Drug Tier||What it means||Cost|
|Tier 1||Preferred generic. These are commonly prescribed generic drugs.||For most plans, you’ll pay around $3 for drugs in this tier.|
|Tier 2||Generic. These are also generic drugs, but they cost a little more than drugs in Tier 1.||For most plans, you’ll pay around $10 to $15 for drugs in this tier.|
|Tier 3||Preferred brand. These are brand-name drugs that don’t have a generic equivalent. They’re the lowest-cost brand name drugs on the drug list.||For most plans, you’ll pay around $35 to $47 for drugs in this tier.|
|Tier 4||Nonpreferred drug. These are higher-priced brand-name and generic drugs not in a preferred tier.||For most plans, you’ll pay around 45% of the drug cost in this tier.|
|Tier 5||Specialty. These are the most expensive drugs on the drug list. Specialty drugs are used to treat complex conditions like cancer and multiple sclerosis. They can be generic or brand name.||For most plans, you’ll pay 33% of the retail cost for drugs in this tier.|
How do I know what tier my drugs are in?
The easiest way to find out what tier your drugs are in is by using your plan’s drug list. When you look up a drug, the second column of the drug list will show you what tier it's in. You can find out more about how to read a drug list in our Help Center.
- Find your plan’s drug list.
Where can I find out how much I’ll pay for drugs in each tier?
Your plan’s Summary of Benefits or Evidence of Coverage will have a section on prescription drug costs. It will break down your copay or coinsurance for each drug tier.