Know what drugs are covered under your plan and how to find the best price.

Prescription drug tiers defined

Access the Approved Drug List specific to your plan type by logging in to your MyHealth account. When browsing the Approved Drug List, you’ll notice that drugs are listed with a tier level. There are nine total tiers on the Approved Drug List. Different tiers denote different costs and coverage as determined by Priority Health, and the type of tiers available to you for each drug will depend on your plan type.

Here's a breakdown of the meaning of each tier (this information can also be found in the Approved Drug List):

  • tier 1 Medicaid icon

    Tier 1: Generic. Equivalent or alternative option to brand-name drugs, but at a lower cost.

  • tier 2 optimized icon

    Tier 2: Preferred Brand. Brand-name drugs that require higher copays than generic, but lower copays than a non-preferred brand drug. These drugs are commonly prescribed and selected based on their effectiveness.

  • Tier 3 optimized icon

    Tier 3: Non-Preferred Brand. Brand-name drugs that require higher copays. These drugs usually have lower cost alternatives with the same or better effectiveness.

  • Tier 4 Medicare icon

    Tier 4: Preferred Specialty. Specialty drugs that are selected based on effectiveness, safety and cost-effectiveness. Specialty drugs that require special handling, are self-administered and are used for chronic illnesses. They require higher copays than a brand-name drug.

  • Tier 5 Medicare icon

    Tier 5: Non-Preferred Specialty. Specialty drugs that require the highest level of copay. These drugs usually have lower cost alternatives with the same or better effectiveness.

  • Tier 6 Medicare icon

    Tier 6: Medical Benefit. Drugs that are covered by your medical plan benefits instead of your prescription plan benefits. Check your coverage documents or call Customer Service for details.

  • Tier 6 optimized icon

    Tier 7: Medical Benefit – Preferred Specialty. Drugs that are covered by your medical plan benefits instead of your prescription plan benefits. Check your coverage documents or call Customer Service for details.

  • Tier 8 optimized icon

    Tier 8: Medical Benefit – Non-Preferred Specialty. Drug that is covered by your medical plan benefits instead of your prescription plan benefits. Check your coverage documents or call Customer Service for details.

  • Tier 9 optimized icon

    Tier 9: Excluded. Drugs that your prescription plan will not pay for or that are not included on the approved drug list. Contact Customer Service for more information


Questions?

Send us a message in your member account or call the Customer Service contact number on the back of your member ID card.