PREVIOUS QUESTION:

 

NEXT QUESTION:

 

What are the tiers of costs for medicines in health plans?

ANSWER

Many health plans have three or four tiers of costs:

You may have a separate deductible for prescription drugs along with one for medical services. Look at a plan's summary of benefits to see what you'll have to pay.

  • Tier 1: Generic medicines, which cost the least
  • Tier 2: Preferred brand-name medicines
  • Tier 3: Non-preferred brand-name medicines
  • Tier 4: Specialty medicines, which are often costly brand-name medicines.

SOURCES:

The Center for Consumer Information & Insurance Oversight, U.S. Department of Health and Human Services: "Essential Health Benefits Standards: Ensuring Quality, Affordable Coverage."

Centers for Medicare & Medicaid Services: "State Pharmaceutical Assistance Programs" and "Copayment/coinsurance in drug plans."

Consumers Union and Consumers Report: "Your Health Plan’s Formulary: The List of Preferred Prescription Drugs."

FAIR Health: "Factors to Consider When Choosing a Health Plan" and "A New Look At Flexible Spending Plans."

Health Reform GPS, Robert Wood Johnson Foundation and the Hirsh Health Law and Policy Program of the George Washington University School of Public Health and Health Services: "Update: Essential Health Benefits Final Rule."

National Conference of State Legislatures: "State Pharmaceutical Assistance Programs."

FDA: "The Possible Dangers of Buying Medicines over the Internet" and "Generic Drugs: Questions and Answers."

U.S. Bureau of Labor Statistics: "Definitions of Health Insurance Terms."

Avalere Health: "Drug Coverage in Essential Health Benefits Benchmark Plans: Formulary Analysis."

American Cancer Society: "Formularies and drug coverage."

Reviewed by Sarah Goodell on February 14, 2018

SOURCES:

The Center for Consumer Information & Insurance Oversight, U.S. Department of Health and Human Services: "Essential Health Benefits Standards: Ensuring Quality, Affordable Coverage."

Centers for Medicare & Medicaid Services: "State Pharmaceutical Assistance Programs" and "Copayment/coinsurance in drug plans."

Consumers Union and Consumers Report: "Your Health Plan’s Formulary: The List of Preferred Prescription Drugs."

FAIR Health: "Factors to Consider When Choosing a Health Plan" and "A New Look At Flexible Spending Plans."

Health Reform GPS, Robert Wood Johnson Foundation and the Hirsh Health Law and Policy Program of the George Washington University School of Public Health and Health Services: "Update: Essential Health Benefits Final Rule."

National Conference of State Legislatures: "State Pharmaceutical Assistance Programs."

FDA: "The Possible Dangers of Buying Medicines over the Internet" and "Generic Drugs: Questions and Answers."

U.S. Bureau of Labor Statistics: "Definitions of Health Insurance Terms."

Avalere Health: "Drug Coverage in Essential Health Benefits Benchmark Plans: Formulary Analysis."

American Cancer Society: "Formularies and drug coverage."

Reviewed by Sarah Goodell on February 14, 2018

NEXT QUESTION:

How can a local pharmacy save me money on medicines?

WAS THIS ANSWER HELPFUL

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

    This tool does not provide medical advice. See additional information.

    Other Answers On: