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:

For coverage dates starting 01/01/2015, 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
  • Rhode Island Small Group 3-tier Drug List: PDF / searchable list
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