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What are "tiers or categories" on a Medicare drug plan's drug list (formulary)?
Many Medicare drug plans place drugs into different "tiers." Drugs in each tier have a different cost. Some plans may have more tiers and some may have fewer. Here is an example:
| Tier |
You Pay |
What is Covered |
Cost Example* |
| 1 |
Lowest
copay |
Most generic prescription drugs |
$5.00 |
| 2 |
Medium
copay |
Preferred brand-name prescription drugs |
$28.00 |
| 3 |
Higher
copay |
Non-preferred brand-name prescription drugs |
$53.00 |
Specialty
Tier |
Higher
percentage |
Unique, very high-cost drugs |
25%-33% of drug cost |
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* These amounts aren't actual costs. They are examples of Copayment or Coinsurance costs for a 30-day supply. Costs vary by plan and by drug.
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(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook 2007. This content may have been added upon by Q1Group LLC to include further examples, explanations, and links.)
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Last updated on: 07/18/2008
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