Understanding Drug Tiers

In this article you will learn that one of the biggest healthcare barriers patients hit can be navigating the details of their prescription drug coverage options. If you know that you’ll need prescription drug coverage, it is important to research and choose a plan that covers your medication. Under a healthcare plan, the list of covered prescription drugs is called a formulary. The formulary is usually divided into tiers or levels of coverage based on the type or usage of the medication. Each tier will have a defined out-of-pocket cost that the patient must pay before receiving the drug. During your research, you’ll want to ensure that if the medication you’re taking doesn’t have a generic version available, you choose a plan that covers brand name prescriptions to help cover part of the cost. You’ll also want to be on look-out for plans that require a co-pay percentage on high-level expensive drugs because these costs are often unaffordable and could leave the beneficiary with an outrageous out-of-pocket responsibility.