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Shelly Rogers
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Nevada Insurance Enrollment Explains Health Insurance Prescription Drug Tier Pricing

Published on 3/19/2019
For additional information  Click Here

Understanding Your Prescription Drug Tier Pricing Can Help You Save Money


Post - What is Tier Pricing With Prescription Medications


Understanding how health insurance companies cover different types of drugs can help Nevada residents save money on their prescription drugs.

Each health insurance company has a formulary, or a list of the drugs that are covered by their plans. In most cases, the drugs listed on a plan's formulary are both effective and affordable.

Within these formularies are tiers, which health insurance companies use to manage their costs. These tiers determine the level of coverage a prescription drug plan offers for a specific type of medication. An insurer's formulary and tier system are available either on the company website or within their enrollment documents.

While most prescription drug plans use a four-tier system, some insurers have additional fifth or sixth tiers.

To promote the use of generics or more cost-effective brand name drugs, health insurance companies may cover a larger portion of the costs for drugs in the first and second tiers. The first tier generally includes generic medications. This tier includes the most cost-effective medications, resulting in the lowest out-of-pocket costs for customers. The second tier includes brand name drugs and more expensive generic medications that are preferred by the health insurance company. In most cases, these drugs are selected for both their effectiveness in treating a condition, as well as their affordability.

The third tier is comprised of brand name drugs that are not preferred by the health insurance company. Customers still receive coverage for tier-three medications, but their out-of-pocket costs are greater than that of a preferred drug.

The fourth tier includes specialty drugs, which are generally associated with a large price tag. Drugs that are used to treat conditions like cancer are generally in this tier.

There are two additional tiers that are not used by all health insurance companies. The fifth tier includes the priciest specialty drugs. The sixth tier is comprised of maintenance medications. In many cases, customers do not pay a copay on these medications.

By understanding a drug plan's formulary and tier pricing, customers can better predict what they will pay at the pharmacy counter. This can help them better afford their medications.

After reviewing their drug plan's tiers, Nevadans may consider speaking with their doctors about the conditions for which they are currently receiving treatment, the medications that they are using and the level of prescription drug coverage they have for a given medication. This will enable their doctors to determine whether there are more cost-effective options.

In addition to speaking with their doctor about their health insurance drug plan, those who are receiving treatment for conditions may wish to speak to a health insurance broker about their medications prior to purchasing a health insurance plan. This may enable them to select a prescription drug plan with a formulary that includes the medications that they are on within the lower tiers.

Nevada Insurance Enrollment health insurance agents are available to help customers evaluate their prescription needs and select a plan that will provide the best coverage.


Learn more:


About Nevada Insurance Enrollment:

Nevada Insurance Enrollment offers the best insurance plans at the lowest price possible.  They are a local Las Vegas, family owned insurance agency that works hard to fit you into the smartest, most affordable insurance that meets your needs.


They care about you, they work for you, they're experienced and they're local.  They are the insurance experts, let them guide you.  Talk with a friendly, knowledgeable, licensed insurance agent.  No agent fee and no charge for their service.  They don’t just sell insurance, they actually care.


Auto | Home | Health | Life | Medicare | Funeral/Cremation | Group Health | Short Term | Dental & Vision | Travel Insurance


Nevada Insurance Enrollment

4260 W. Craig Road suite #150-A

North Las Vegas, NV  89032

(702) 898-0554


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