Drug Tiers
Among the many health insurance terms that may be confusing, “drug tiers” is frequently used in explanations of prescription drug coverage. You may see “drug tiers” in many of the different plan options and descriptions, but you may be unsure of what this term actually means. Vantage can help explain!
Drug tiers are used by health plans to classify and group certain prescription drugs. The differences in tiers correspond to the cost of the drugs, meaning that the lower tiers include more affordable drug options than the higher tiers. Choosing prescription drugs on lower tiers allows you to save money on your prescription medications.
Another important distinction between prescription medication classifications and drug tiers is the designation of generic drugs and brand-name drugs. According to the Food and Drug Administration (FDA), a generic drug is defined as a medication that is created to be the same as an existing approved brand-name drug in:
- dosage form,
- safety,
- strength,
- route of administration,
- quality, and
- performance characteristics.
In other words, generic medicines provide the same clinical benefits as the brand-name versions. Generic drugs are usually located in lower-cost drug tiers. Brand-name drugs are included in higher-cost drug tiers. Drug tiers are often labeled by drug type (ie, generic brand or specialty).
On most plans, Vantage offers prescription drugs in five (5) drug tiers:
Tier 1 includes preferred generic drugs. You will have little or no cost share for the medications in this tier.
Tier 2 has other generic drugs included. However, you will pay a little more for Tier 2 generic drugs than for Tier 1 preferred generic drugs.
Tier 3 includes preferred brand-name drugs. These brand-name medications cost more than generic drugs. Use the applicable plan formulary (list of covered drugs) to see if there is a generic version of your drug as an alternative to preferred brand-name drugs.
Tier 4 includes non-preferred brand-name drugs. You will be required to pay more for these brand-name drugs as compared to Tier 3’s brand-name drugs.
Tier 5 includes specialty drugs. These drugs are high-cost medications that are used to treat complex conditions. Because of their specialized nature, they usually cost more than prescription drugs in the other drug tiers.
We hope that you have a better understand of drug tiers and that this will help you in your search for the plan that is right for you! To find your prescription drug’s tier(s), please view Vantage’s formulary at www.vantagehealthplan.com/members/pharmacybenefits or call our Member Services team at 888-823-1910.
