Last Update: August, 2020. National Drug List 3-Tier.

Any healthcare payer will make its formulary available to you because they want you to have it and use it—your low out-of-pocket costs usually translate to low costs for your payer. * Drugs@FDA includes information about drugs, including biological products, approved for human use in the United States (see FAQ), but does not include information about FDA-approved products regulated by the Center for Biologics Evaluation and Research (for example, vaccines, allergenic products, blood and blood products, plasma derivatives, cellular and gene therapy products). It is available in generic and brand versions. If you take a drug on a daily or regular basis, you may be notified when a shift takes place. You'll want to double-check each year during open enrollment, when you have the opportunity to make changes to your coverage plan, to see if your drug has shifted its position in the payer's formulary.

If they do that successfully, that drug can become a "preferred brand," which usually means it becomes a Tier II drug. All Rights Reserved Albuterol (Ventolin, Proair, Proventil) is an inexpensive drug used to treat and prevent bronchospasm.This drug is more popular than comparable drugs. A drug class describes a group of drugs that all treat the same condition. Verywell Health uses cookies to provide you with a great user experience and for our If you have a basic understanding of drug classes and tier pricing, you can work with your doctor to choose the drug that will cost you the least. Click a plan to look up drugs, get prices, find in-network pharmacies and more. To view a PDF version of this, or any/all of our drug lists/formulaires,Your coverage has limitations and exclusions, which means that some drugs on this list may not be covered, depending on your plan’s design. There are brand-name versions of albuterol available, but they are not interchangeable. This data is often used by insurers to support placing high-cost drugs on a high tier if generics work just as well. The full formulary is often available on a payer website, or you can call the customer service number and ask them to mail it to you. If you have private insurance or government coverage for your prescriptions, familiarizing yourself with your payer's medication formulary can save you time and money.

Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.What Is a Health Insurer's Drug Formulary and Tier Pricing? Review the prescription class, and find your medication's position in your payer's formulary to make sure you are getting the drug you need for the least amount of out-of-pocket cost to you.

An exception occurred while searching for this drug. Find out more by going online to anthem.com or by calling the phone number for your health plan listed ©1997-2020 Managed Markets Insight and Technology, LLC. For additional information, please call the customer service number on your ID card.Most plans include our home delivery program at no extra cost to you. Search the list of FDA-approved drugs and coverage for each by entering a drug name below.


Similarly, doctors often use it as evidence for pre-authorization requests when they are concerned that a generic may not work as well as a brand. If they can't negotiate it low enough, it will be placed in Tier III and it will usually cost patients a higher co-pay as well. The example shown is a Value 5-Tier plan. Not all dosage forms of the drugs listed above are covered. Read our These drugs may have a lower cost alternative on Tier One or Tier Two.

Tier III drugs usually require a pre-authorization, with your doctor explaining to your health insurer why you need to take this particular drug instead of a cheaper option. She has written several books about patient advocacy and how to best navigate the healthcare system. To find out more, please refer to yourPreventive care drugs: We cover preventive care drugs with zero cost share in compliance with the Affordable Care Act (ACA).
James Lacy, MLS, is a fact checker and researcher. Different drugs in each drug class are listed in different tiers based on cost. Your prescription drug benefit includes coverage for medicines that you’ll find on the Drug List. Compare short-acting beta agonists.

A formulary generally lists many drugs and ranks them in groups described as tiers. We cover contraceptives for members enrolled in a California plan according to state regulations.Member cost share amounts for certain abuse-deterrent opioid analgesics may be lower in the state Maine due to state laws. Search by medication name for up-to-date drug information, including the benefit tier your drugs are on, as well as applicable clinical edits such as prior authorization or step therapy requirements. Tier 1 or Tier 2 for products found in this highest tier. No Results Found, Please try again. James received a Master of Library Science degree from Dominican University. It's not unusual for a payer to make changes to its formulary or to move a drug from one tier to another. Tier II drugs may require a pre-authorization from your insurance company.

A payer might negotiate a price with the manufacturer or distributor of one of the more expensive drugs, like Aciphex or Nexium, to a very low point.