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.

What does each drug tier mean?

Here’s a breakdown of each tier. The estimated cost information is for a one-month supply of drugs from an in-network preferred pharmacy.

Drug Tier What it means Cost
Tier 1 Preferred generic. These are commonly prescribed generic drugs. For most plans, you’ll pay around $1 to $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 $7 to $11 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 $38 to $42 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% to 50% 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 25% to 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.

Where can I find out how much I’ll pay for drugs in each tier?

Your plan’s Summary of Benefits will have a section on prescription drug costs. It will break down your copay or coinsurance for each drug tier.

Tip: Keep in mind that you’ll pay full price for prescription drugs if you haven’t met your plan’s pharmacy deductible. You’ll also pay more when you’re in the coverage gap, or donut hole. You can learn more about the donut hole and the different levels of prescription drug coverage in our Help Center.