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Tier Classifications

Note: Individual plans may vary and formulary information changes. You are encouraged to contact the prescription drug benefit provider for the most current formulary information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3P Preferred – This drug is available at a preferred co-pay. Most commonly used when Tiers 1 and 2 apply to preferred generic and non-preferred generic drugs, respectively.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
7 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC Not Covered
Drugs that are not covered by the plan.
N/A Not Available
Formulary data for this drug/health plan are not available.