- Commercial Plans Pharmacy
- 3-Tier Pharmacy Copayment Program
- Frequently Asked Questions
- How to Use Your Pharmacy Benefit
- How We Manage Our Prescription Drug Benefit
- MA 4-Tier Pharmacy Copayment Program
- Mail Order Pharmacy Program
- Non-Covered Drugs With Over-The-Counter Alternatives
- Pharmacy Program
- RI 4-Tier Pharmacy Copayment Program
- Where to Fill Your Prescriptions
3-Tier Pharmacy Copayment Program
Prescription drug prices vary tremendously - including drugs used to treat the same condition. We sort prescription drugs into three tiers to help you and your doctor choose the most cost-effective option for the medication you need. Each tier has a specific copay amount that you pay when you fill or order your prescription.
- If your doctor prescribes a Tier-3 drug, you can work with him or her to determine if there is an appropriate drug available that will be less costly.
- Depending on your plan, coverage for prescription drugs may be subject to an annual deductible amount or be limited to our generic-focused drug list.
- Tier placement is subject to change throughout the year.
|Tier Level||Tier Copay||Tier Description|
|Tier 1||Lowest copayment||Medications on this tier have the lowest copayment. This tier includes many generic drugs.|
|Tier 2||Middle copayment||Medications on this tier are subject to the middle copayment. This tier includes some generics and brand-name drugs.|
|Tier 3||Highest copayment||This is the highest copayment tier and includes some generics and brand-name covered drugs not selected for Tier 2.|
Look up Your Medication to Determine Tier Level and Special Coverage Considerations
For coverage dates starting 01/01/2016, please refer to the following links:
- Massachusetts Individual and Small Group 3-tier Drug List: PDF | searchable list
- Massachusetts Individual and Small Group 4-tier Drug List: PDF | searchable list
- Rhode Island Individual and Small Group 3-tier Drug List: PDF | searchable list
- Rhode Island Individual and Small Group 4-tier Drug List PDF | searchable list
- Massachusetts Large Group 3-tier Formulary
- Massachusetts Large Group 4-tier Formulary
- Rhode Island Large Group 3-tier Formulary
- Rhode Island Large Group 4-tier Formulary
For coverage dates starting 01/01/2015, please refer to the following links: