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What’s the Deal With Medication Tiers?

Medication tiers are how insurance plans sort drugs by cost, and they impact what you pay at the pharmacy.
Lower tier medications (generics) usually cost less, while higher tiers (brand names or speciality drugs) cost more.
Some medications aren’t covered by insurance at all, no matter what tier.
A prescription discount card like Visory Health can help you save on medications your insurance won’t cover, or doesn’t cover well.

Why Does Your Prescription Cost So Much?

You just went to pick up your prescription, and the number the pharmacist said is…unfortunate. You’re not alone in feeling that – medications can be extremely expensive, and it doesn’t always make sense. Some of the confusion around prescription medication pricing comes down to medication tiers. We’ll break down what that means below.

What Are Medication Tiers?

Medication tiers are how insurance companies organize drugs into cost categories. Most plans use a formulary, which is basically a list of covered drugs, split into tiers. The lower the tier, the less you typically pay.

Here’s a simple breakdown of how tiers usually work:

Tier 1 - Generic Drugs: The most affordable options. These work the same as brand-name versions but cost less. Medications that have been around for longer tend to have generics more readily available.
Tier 2 - Preferred Brand-Name Drugs: These are brand-name medications your insurer often prefers you use, usually because they’ve negotiated a lower rate.
Tier 3 - Non-preferred Brand-Name Drugs: Brand-name options that cost more because they’re outside of your insurer’s preferred list.
Tier 4 (or higher) - Specialty Drugs: These treat complex conditions and often carry the highest price tags. These can include high-cost medications or newly-approved medications for complex or serious conditions.

Every insurance plan structures tiers a little bit differently, so it’s worth checking your plan’s formulary. A lot of times you can check your plan’s formulary by logging in to your online member portal, looking at plan documents, or calling the help line on your insurance card.

What Happens When a Medication Isn’t Covered?

Here’s where things get tricky. Sometimes a medication isn’t on your insurance plan’s formulary at all. That means no tier, no coverage, and (without help) you’re paying the full retail price.

This happens more than people realize. Insurance formularies change, drugs get dropped, and sometimes a medication your doctor prescribes just isn’t on the list. It’s frustrating, especially when you need that specific medication and switching isn’t an easy option.

**How Rx Discounts Cards Work Outside of Insurance**

If your medication isn’t covered by your insurance, a prescription discount card like the Visory Health Rx Savings Card comes in handy.

Rx discount cards don’t work through your insurance’s tier system at all. Instead, the tap into pre-negotiated pricing with your pharmacy, separate from your insurance formulary altogether. In simpler terms, that means:

A medication on a high insurance tier (or not covered at all) might still be affordable with a prescription discount card like Visory Health.
You can compare your insurance copay against your Visory price and use whichever is lower.
You can use Visory’s price search tool to know your potential savings, before heading to the pharmacy.

In other words, tiers only matter if you’re using insurance to fill that prescription. With a discount card, you’re working with a completely different pricing system - one built to save you money, tier or no tier.

How to Get Your Visory Price

It’s simple and easy:

Search your medication using the Visory Health Price Search Tool.
Compare it to your insurance copay (if you have coverage).
Ask your pharmacist to use Visory Health for Rx savings, or show them your digital or physical Visory card.

We work at thousands of pharmacies nationwide, and our simple Rx savings can mean getting up to 80% off on your medications – even the ones insurance doesn’t cover! Plus, we now offer Home Delivery, which means you can get your medications delivered anywhere in the U.S., with the Visory savings already built in.

FAQ: Medication Tiers

Q: How many medication tiers are there?

It varies by plan, but most insurance formularies use 3-5 tiers – generics, preferred name-brand drugs, non-preferred name-brand drugs, and one or two speciality tiers for complex conditions. Check your plan’s formulary for the exact breakdown.

Q: Who decides which tier a medication is placed in?

Your insurance company (or its pharmacy benefit manager, commonly referred to as a PBM) sets the tiers, usually based on cost, whether a generic version exists, and negotiated deals with the drug manufacturers. It’s not based on how well a drug works, just on pricing and contracts.

Q: Why did my medication move to a higher tier?

Insurance companies update their formularies regularly, sometimes once a year, sometimes more often. A drug can shift tiers if a cheaper generic becomes available, if a manufacturer changes pricing, or if your insurer renegotiates its contracts. If this happens, it’s worth comparing your new copay to your Visory price.

Q: Can a prescription discount card be used on high-tier medications?

Yes! Discount pricing isn’t based on insurance tiers at all, so even Tier 3 and above medications, or speciality medications, may be more affordable with a prescription discount card than with your plan’s tier system.

Q: What if my medication isn’t listed on my insurance formulary?

That’s exactly when a prescription discount card is most helpful. It gives you a price option even when the medication has no tier and/or no coverage at all.

Q: Is there a cost or premium to use the Visory Health Simple Rx Savings Card?

No – it’s completely free! No premiums, no subscriptions, just simple and easy Rx savings.

We’re Tier for You

Here’s the truth: insurance tiers were built around insurance’s rules, not around what’s actually affordable for you. You shouldn’t have to accept a high copay or no coverage at all, simply because that’s where your medication landed on their formulary. You have a choice, and that choice takes less than a minute to explore.

Before your next refill, take thirty seconds to check your Visory price. If it’s lower than your copay, amazing! You’re saving money on the spot! If it’s higher, no harm is done; stick with your insurance. Either way, you’re making an informed decision instead of just accepting whatever number shows up at the counter. Comparing prices isn’t complicated, and it isn’t a hassle – it’s just smart.

Insurance tiers can be confusing, but your prescription savings don’t have to be. Download your Rx Savings Card or search your price today, and let us take the guesswork out of your next pharmacy visit. We see you. We hear you.

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🧡 We do healthcare differently®,

The Visory Health Team

","disclaimer":"

This article is not medical advice. It is intended for general informational or educational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition, diagnosis or treatment. If you think you have a medical emergency, immediately call your physician or dial 911.

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