How Prescription Drug Tiers and Prices Works?

how prescription drug tiers and prices works

Understanding how prescription drugs tiers and prices works. To avoid paying for unexpected high drug costs. Higher drugs tiers may cost more out of pocket than lower drugs.

If you would like to know how much your prescription drugs will cost you. This information will give background on how prescription drug tiers and prices works.  Do you ever feel like predicting a movie scene would be easier than medical cost?  Well, you are not alone.  The good news is when it comes to prescription drugs, the tiers can help you make a smart guess how much you will pay.

Drug tiers are divided prescription drugs into different levels of cost.  The Tier 1 Drugs will be cheapest options.  But Tier 5 Drugs is the most expensive.

What Does Each Drug Tier Mean?

Here is a breakdown of each drug 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.  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 Non-preferred drug. There are higher-priced brand-name and generic drugs that is not in the preferred tier. For most plans, you’ll pay around 45% of the drug cost in this tier.
Tier 5 Specialty. So, the most expensive drugs on the drug list. Specialty drugs used to treat complex conditions like cancer and multiple sclerosis. They can be the generic or brand name. For most plans, you’ll pay 33% of the retail cost of drugs in this tier.

How will I know what tier my drugs are in?

The best way to find out what tier your prescription drugs are in by utilizing the plan’s drug list.  When looking up a drug, in the second column of the drug list it will show you what tier it is in.

How Can I Find Out How Much I Will Pay For Drugs In Each Tier

The prescriptions drug cost is on the Benefits of Evidence or plan’s Summary of Benefits.  It will give your copay or coinsurance for each tier.

  • Find your plan’s Evidence of Coverage or Summary of Benefits.

Tips: You probably have to pay full price for prescription drugs if you have not met your pharmacy plan’s deductible.  Also, you pay more if you are in the coverage gap or donut hole.  Learn more about the donut hole and different levels of prescription drug coverage at

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