Ever wonder why some medications cost more than others? It’s all about drug tiers. Drug tiers divide prescription drugs into different price points.
Learning how drug tiers work with Blue Cross Blue Shield of Michigan can help you understand what you’ll pay for your prescriptions.
Keep in mind that you'll pay full price for prescription drugs if your Medicare plan has a pharmacy deductible you haven't met. Depending on your plan, you may also pay more when you're in the coverage gap, or donut hole.
Here’s an overview of each drug tier, along with your estimated costs for a one-month supply of drugs from an in-network preferred pharmacy:
These are commonly prescribed generic drugs. For most plans, you'll pay around $0 to $1 for drugs in this tier.
These are also generic drugs, but they cost a little more than Tier 1 drugs. For most plans, you'll pay around $7 to $11 for drugs in this tier.
These are brand-name drugs that don't have a generic equivalent. They're the lowest-cost brand-name drugs on the drug list. This tier also includes some high-priced generic drugs. For most plans, you'll pay around $37 to $45 for drugs in this tier.
These are higher-priced brand-name and generic drugs not in the preferred tier. For most plans, you'll pay around 45% to 50% of the drug cost in this tier.
These are the most expensive drugs on the drug list. Specialty drugs are used to treat conditions like cancer and multiple sclerosis. They can be generic or brand name. For most plans, you'll pay 25% to 33% of the retail cost for drugs in this tier.
The easiest way to find out what tier your drugs are in is by using your Medicare plan's drug list. When you look up a drug, the second column of the drug list will show you what tier it's in.
Need help? We can help you learn how to read a drug list.
Your plan's Summary of Benefits has a section on prescription drug costs. It breaks down your copay or coinsurance for each drug tier.