What are the three tiers of pharmacy benefits?

What are the three tiers of pharmacy benefits?

• A. Tier 1: Brand, Tier 2: Formulary, Tier 3: Generic.
• B. Tier 1: Generic, Tier 2: Non-formulary, Tier 3: Formulary.
• C. Tier 1: Generic, Tier 2: Formulary, Tier 3: Non-formulary.
• D. Tier 1: Generic, Tier 2: Formulary, Tier 3: Specialty.

Answer: (C)

Pharmacy benefits are typically structured in tiers that determine how much you pay. The first tier is Generic because generics provide the same therapy at the lowest cost. The second tier is Formulary, which includes drugs that are on the plan’s approved list and covered with a moderate copay for formulary options, whether generic or brand-name. The third tier is Non-formulary, referring to drugs not on the formulary that usually aren’t covered or require extra authorization and higher out-of-pocket costs. So, the standard three tiers are Generic, Formulary, Non-formulary. Other choices mix in terms like Brand or Specialty or rearrange the order, which isn’t how typical pharmacy benefit designs are set up.

Pharmacy benefits are typically structured in tiers that determine how much you pay. The first tier is Generic because generics provide the same therapy at the lowest cost. The second tier is Formulary, which includes drugs that are on the plan’s approved list and covered with a moderate copay for formulary options, whether generic or brand-name. The third tier is Non-formulary, referring to drugs not on the formulary that usually aren’t covered or require extra authorization and higher out-of-pocket costs.

So, the standard three tiers are Generic, Formulary, Non-formulary. Other choices mix in terms like Brand or Specialty or rearrange the order, which isn’t how typical pharmacy benefit designs are set up.