What's a Formulary Tier Home Care Path

A formulary is a list of drugs your plan will cover. Drugs on the formulary are grouped in to tiers. The co-payment you pay is determined by the tier that your medication falls under. Tier one will have the lowest co-payment and usually include generic medications.

Tier two has a higher co-payment than tier one and usually includes preferred brand name medications. The plan may have negotiated a lower purchase price with the pharmaceutical company for a preferred brand name drug. This lower price allows the drug to be placed in tier two rather than tier three.

Tier three has the highest co-payment and usually includes non-preferred brand name medications. The health plan will place medication on tier three because it is new, or not fully proven to be effective for the described use. The medication can be in tier three because there is a similar drug on a lower tier of the formulary, that may provide you with the same benefit, at a lower cost.

Some plans will provide the consumer with a list of medications not covered. Typical non- covered drugs include over the counter medications, and some weight loss drugs.