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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


* 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.

(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)


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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
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  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
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