Tiered Copay Structure
Our 3-tier pharmacy program helps ensure that you and your doctor have a wide choice of covered medications for your prescription needs, while still being affordable. This plan lets you and your doctor choose from different medications with different copayments.
The amount you pay for each prescription—your copayment—is determined by a tier structure indicated on your member card.
Tiers (Copayment Levels)
- Tier 1. Most generic medications have the lowest copayment. The amount you pay may be found beneath your name on your ID card after RX copays. Tier 1 is indicated by the first number on your ID card.
- Tier 2. Preferred brand-name medications have a slightly higher copayment, indicated by the second number on your ID card.
- Tier 3. Non-preferred medications (the vast majority of which have generic or preferred brand-name alternatives) require the highest copayment, indicated by the third number on your ID card.
An Important Resource
To check which level a medication is on, please go to our website www.bluecrossma.com and click on
- Nearly all Tier 3 medications have an approved generic medication covered at Tier 1 or an alternative brand-name medication covered at Tier 2.
- A list of non-covered medications also exists. If you receive a formulary exception for a non-covered medication, you will continue to have access to that medication, but will pay the Tier 3 copayment for the prescription.
Please check with your plan sponsor or employer for additional details about your plan.