Tier Classifications
TIER 1
Usually, these are generic drugs available at the lowest co-pay.
TIER 2
Usually, these are “preferred” (or on formulary) brand name drugs.
TIER 3
Usually, these are "non-preferred" brand drugs, which require higher-level co-pay.
TIER 4-9
Usually, these are "non-preferred" brand drugs or specialty prescription products, which require higher-level co-pay.
Tier Definitions
N/C
Not Covered: This plan does not cover the drug.
N/A
Not Available: We are not able to provide formulary data for this drug/healthcare plan.
Please note: Plans and formulary information are subject to change. Please contact the prescription drug benefit provider for current formulary information.
Restrictions
PA
Prior Authorization: A drug that requires additional documentation before a prescription is approved and filled. Specific clinical criteria must be met prior to the approval.
QL
Quantity Limits: For safety and cost reasons, plans may set quantity limits on the amount of drugs they cover over a certain period of time.
ST
Step Therapy: A drug written for step therapy; restrictions for such a drug usually require that certain criteria be met before a prescription is approved.