What is an RX Tier & Why is it Important?

Thursday, 23 September 2021

Rx Tier

Has your doctor ever prescribed you a new medication and you’ve left their office wondering how much out of pocket this new med is going to cost? The doctor’s job is to provide you with care and good bedside manner, but sometimes the meds they prescribe you cost more than you expected or wanted to pay!

If you are on a copay insurance plan, you are going to have what are called “prescription or RX tiers”. There are 4 tiers that prescriptions fall under; the first tier is where the most cost-effective prescriptions are going to fall, and the fourth tier is where the most expensive prescriptions are going to fall!

Here’s how you can figure out how much that new prescription is going to cost you based on its tier:

  1. Call your insurance company and provide the name of the prescription and dosage and they can tell you which tier the RX is under
  2. Ask your insurance company for the prescription formulary! The prescription formulary is an extensive list of prescriptions that the insurance company covers that you can search by condition or alphabetization and see what tier the RX falls under on the formulary

It’s so important to know the cost of your medication before you get hit with a surprise bill at the pharmacy counter. So, give Clevenger Insurance a call today at 574-267-2181 to request a personal consultation so we can walk you through this process!

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