How to Read the Legend
Use this handy guide to help you understand your out-of-pocket costs and if the drug has any specialty steps that need to be followed before it is covered under your insurance.
The status column lets you know what tier the drug is on. The lower the tier, the lower your out-of-pocket costs.
Tier 1 means the drug is a preferred generic drug. Your out-of-pocket costs are lowest with Tier 1 drugs.
Tier 2 means the drug is a preferred brand-name drug. Your out-of-pocket costs are higher with Tier 2 drugs.
Tier 3 means the drug is a non-preferred generic or brand-name drug. Your out-of-pocket costs are more expensive for Tier 3 drugs.
Tier 4 means the drug is a specialty or high-cost drug. Your out-of-pocket costs are the highest for Tier 4 drugs.
The Notes & Restrictions column lets you know if you need to follow special steps for the drug to be covered. Pay special attention to the following:
Specialty Drugs: These drugs must be filled through CVS Caremark Specialty Pharmacy.
Prior Authorization: Your doctor will need to request approval for these drugs to be covered by your pharmacy benefits.
Step Therapy: These drugs will be covered if you've already tried one or more other drug on the CoOportunity Health Drug List.
Quantity Limit: These drugs have limits on how much you can receive each time you fill your prescription.
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