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Coverage and cost


  • The plan I'm looking at says I have a 3, 4, or 5 tier formulary. What does that mean?

    Usually, a plan will have different tiers, or levels of coverage for medicines. You may see plans with one to five tiers. Generally, the lower the tier, the lower the cost of the medicine. Here’s an example of how a plan might list medicines:

    • Tier 1 drugs - the lowest-cost, mostly generic drugs.
    • Tier 2 drugs - medium-cost drugs, most are generic and some brand-name drugs.
    • Tier 3 drugs - high-cost drugs, mostly brand-name drugs.
    • Tier 4 drugs - the highest-cost drugs, mostly brand-name, newer drugs.
    • Tier 5 drugs - highest-cost drugs, can include specialty medicines.