Formulary Tier

Also called: specialty tier, drug tier

A formulary tier is the cost level a plan assigns to a covered drug, with lower tiers usually holding inexpensive generics and higher tiers holding brand-name or specialty medications. Your copay or coinsurance depends heavily on which tier your drug lands in. If a needed drug sits on an expensive tier, a tiering exception can sometimes lower your cost.

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Disclaimer: This definition is provided for general educational purposes only and is not legal, medical, or insurance advice. Insurance rules, deadlines, and terminology vary by plan, state, and over time. Always check your own plan documents and confirm current details before acting.