Medications are assigned to one of four, five or six categories known as copayment or coinsurance tiers, based on drug usage, cost and clinical effectiveness. Our prescription drug search can show you which tier applies to a specific medication based on your benefits plan.
Copayment Definitions for the Four-Tier Formulary
| Tier 1 | The prescription drug tier which consists of the lowest cost tier of prescriptions drugs, most are generic. |
| Tier 2 | The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and some brand-name prescription drugs. |
| Tier 3 | The prescription drug tier which consists of higher-cost prescription drugs, most are brand-name prescription drugs, and some are specialty drugs. |
| Tier 4 | The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs. |
Copayment Definitions for the Five-Tier Formularies
| Tier 1 | The prescription drug tier which consists of the lowest cost tier of prescription drugs, most are generic. |
| Tier 2 | The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and some brand name prescription drugs. |
| Tier 3 | The prescription drug tier which consists of high-cost prescription drugs, most are brand-name prescription drugs. |
| Tier 4 | The prescription drug tier which consists of the higher-cost prescription drugs, most are brand-name prescription drugs, and some specialty drugs. |
| Tier 5 | The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs. |
Copayment Definitions for the Six-Tier Formularies
| Tier 1 | The prescription drug tier which consists of the lowest cost tier of prescription drugs, most are generic. |
| Tier 2 | The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and some brand name prescription drugs. |
| Tier 3 | The prescription drug tier which consists of high-cost prescription drugs, most are brand-name prescription drugs. |
| Tier 4 | The prescription drug tier which consists of the higher-cost prescription drugs, most are brand-name prescription drugs, and some specialty drugs. |
| Tier 5 | The prescription drug tier which consists of some of the highest-cost prescription drugs, most are specialty drugs. |
| Tier 6 | The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs. |
Additional Consideration
- During a government issued public health emergency, the member expense may change for certain prescription drugs, reducing the out-of-pocket cost to the member.
- Currently, due to the federally issued opioid epidemic, some members may see a reduction in the cost of select Naloxone products.
- Affordable Care Act (ACA) medications are available at $0 cost share to all qualified members. Please visit www.bluecrossnc.com/preventive for more information.
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