What are drug tiers?

What are drug tiers?

There are typically three or four tiers: Tier 1: Least expensive drug options, often generic drugs. Tier 2: Higher price generic and lower-price brand-name drugs. Tier 3: Mainly higher price brand-name drugs. Tier 4: Highest cost prescription drugs.

What does prior authorization for a prescription mean?

What is a Prior Authorization? A prior authorization (PA), sometimes referred to as a “pre-authorization,” is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

What is the generic name of a drug?

Generic name, drug: The term “generic name” has several meanings as regards drugs: The chemical name of a drug. A term referring to the chemical makeup of a drug rather than to the advertised brand name under which the drug is sold. A term referring to any drug marketed under its chemical name without advertising.

Are generic drugs the same?

Generic medicines work the same as brand-name medicines A generic medicine is required to be the same as a brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality, as well as in the way it is taken. Generic medicines also have the same risks and benefits as their brand-name counterparts.

What is a Tier 5 medication?

Tier 5 – Nonpreferred Specialty: In Tier 5 are nonpreferred specialty drugs that likely have a more cost-effective generic or preferred alternative available. Tier 5 has the highest copayment for specialty drugs. In some cases, they may not be covered.

Can generic drugs be less effective?

Are generic name drugs less effective? No. Generic medications are just as effective as brand-name drugs. According to the FDA, drug makers must prove that generic medications can be substituted for brand-name drugs and offer the same benefits as their brand-name counterparts.

What is a Tier 6 medication?

The prescription drug tier which consists of some of the highest-cost prescription drugs, most are specialty drugs. Tier 6. The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs.

What is a Tier 3 drug?

Level or Tier 1: Low-cost generic and brand-name drugs. Level or Tier 2: Higher-cost generic and brand-name drugs. Level or Tier 3: High-cost, mostly brand-name drugs that may have generic or brand-name alternatives in Levels 1 or 2.

Why do prior authorizations get denied?

Insurance companies can deny a request for prior authorization for reasons such as: The doctor or pharmacist didn’t complete the necessary steps. Filling the wrong paperwork or missing information such as service code or date of birth.

Why does it take so long to get a prior authorization?

Obtaining a prior authorization can be a time-consuming process for doctors and patients that may lead to unnecessary delays in treatment while they wait for the insurer to determine if it will cover the medication. Further delays occur if coverage is denied and must be appealed.