I'm confused about the different tiers in Medicare Part D plans. How do they affect what I pay for my medications?

Question

Anthony Castelluccio · Accepted Answer

Normally there are 5 tiers with most prescription plans. Tier 1 is preferred generic, Tier 2 is generic, Tier 3 preferred Brand name prescriptions, Tier 4 Nonpreferred And Tier 5 is speciality drugs. Most cases. The lower the Tier, the lower your co-pay. But that's not true all the time, it depends on your prescriptions that you take, your zip code you live in, and what Pharmacy you like to use. I will show you how you can check to see which prescription plan is the best for you and it could change annually!

Answered by Anthony Castelluccio on April 4, 2025

Agent Licensed in PA, DE, MD, NJ & VA

Answered by Anthony Castelluccio Medicare Insurance Agent

Steve and Sue Brauer · Answer

Hi. Thanks for watching. So when people talk about the different tiers of Medicare Part D plans, the Part D is the prescription drug piece of Medicare. Every drug has a tier, typically five or six tiers. Tier one is gonna be your preferred generic, which is typically zero dollars. Then it goes to generic and so on. Depending on the medications you take, you're gonna want to strategize, or your broker is gonna want to strategize what Part D plan is the best one for you based on those medications, because not all formularies are the same. You could have one... like, Humana could have one formulary and Aetna could have a different one. It just depends on what's the best fit for the drugs you take currently.

Mark Bilgere · Answer

The Part D tiers are often a point of confusion for many people. Here are some simple ways to think about them.

The Tiers are generally numbered 1-5. The lower the number equals a lower price

Tier 1 – Preferred generics (lowest cost): These are the common meds a lot of us take. Often $0

Tier 2 – Generic drugs: These are less common, but still relatively inexpensive

Tier 3 – Preferred brand-name drugs: Start getting expensive. If you see it advertised on TV,  it's a Tier 3 or higher

Tier 4 – Non-preferred drugs: Expensive but often have a lower cost alternative

Tier 5 – Specialty drugs (very high cost) You know if you take one of these

Keep in mind that different carriers may place the same medication in different tiers. Although most are in the same category, it is not a requirement. Make sure you check your medication costs each year.

Larry Dalton · Answer

Medicare Part D drug tiers are the drug manufacturers' way of controlling costs. It is extremely important to make sure that your drugs are in the formulary, and these tier structures change annually. All Medicare Part D stand-alone drug plans and the Part D drug plans embedded in the Medicare Advantage plans must be analyzed yearly to ensure that you have the proper plan to cover your prescription drugs. Many drug plans utilize the tier structure to determine whether to allow the drug to be used towards the annual deductibles of that drug plan; this should be paid special attention to when selecting a drug plan.

Answered by Larry Dalton on April 3, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Terri Reagin · Answer

Really the only way to know the TRUE cost of what you are going to pay is to have someone plug it into a prescription calculator for you or of course, you can attempt to do it yourself but the brochures are simply a guide. They are not going to tell you if a drug is cheaper than the standard copay or if there is a manufacturers savings that has been passed on to you. That is why I never do a medicare appointment without plugging in the medications.

Answered by Terri Reagin on August 5, 2025

Broker Licensed in OK, AR, CO & 6 other states

Answered by Terri Reagin Medicare Insurance Agent

George Ibanez · Answer

Most Medicare part D plans have the medications classified in Tier 1,2,3,4,and 5 and the rule of thumb is very simple, and the lower the tier of the medication the lowest the price, and the higher the tier, the higher the price.

Answered by George Ibanez on February 9, 2026

Broker Licensed in AR, AL, AZ & 40 other states

Answered by George Ibanez Medicare Insurance Agent

Gregg Matheny · Answer

The tier system is Medicare‘s way of breaking down the severity of medication’s, which does directly correlate to its cost. Part D plans classify different medication’s in different tiers, which means that just because one plan covers a medication at a tier 1 generic and charges a low cost for it does not mean that a different part D plan will have that same cost. Tier 1 and 2 are your generic medication’s and will usually either have a zero dollar or very low cost. Tier 3,4 and 5 are brand-name medication‘s all the way up to specialty medication‘s and will more than likely have a deductible that you have to meet, then, after that, you will pay a larger cost for those medications. The higher the tier the higher the cost.

Answered by Gregg Matheny on April 13, 2026

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Ravi Natarajan · Answer

Drugs are placed in different Tiers based on cost, primarily. The best way to determine what your cost would be is to complete your profile and schedule an appointment with me 48 hours after completing your profile
Regards,
Ravi

Sandy Johnson · Answer

Medications are grouped by carrier in tiers. Those tiers are typically 1-5. Tiers 1 and 2 are typically your generic lower cost medications while tiers 3-5 are higher in cost. Each carrier has their own formulary and can differ from carrier to carrier as to which tier a medication falls in. That's why it is important to know prescription drug cost when selecting a carrier for your medications because cost will vary.

Answered by Sandy Johnson on September 29, 2025

Broker Licensed in LA, AL, AR & 11 other states

Answered by Sandy Johnson Medicare Insurance Agent

Mitch Anderson · Answer

There are normally 5 tiers of medication on a Medicare Part D plan. Tiers 1 and 2 are generally generic medications, Tier 3 and 4 are generally brand name medications and Tier 5 is generally for specialty medications. One medications may be listed as Tier 1 on one Part D plan and may be listed as Tier 2 or Tier 3 on another Part D plan; there is not consistency on tiers from one plan to the next so it is always important to discus your plan options with an agent before enrolling in a plan. Usually, the higher the tier for a medication, the higher the risk of copay / coinsurance will be when filling the medication at the pharmacy.

Answered by Mitch Anderson on June 10, 2025

Agent Licensed in MN, IA & WI

Answered by Mitch Anderson Medicare Insurance Agent

Ron Kaemmerer · Answer

That's a great question! Medicare Part D drug tiers are basically how your insurance company organizes the medications they cover, and they directly affect how much you pay out of your pocket.

Think of the tiers like price categories on a menu.

Tier 1: Lowest Cost (Often Preferred Generics)

What it is: Usually the cheapest, most common generic drugs.
What you pay: The least. Often a very low fixed copay (like $1-$10) or sometimes even $0.

Tier 2: Medium Cost (Generics and Non-Preferred Generics)

What it is: Still generic, but maybe a bit more expensive than Tier 1.
What you pay: A low-to-medium fixed copay (more than Tier 1, but still good).

Tier 3: Higher Cost (Preferred Brand Drugs)

What it is: Brand-name medications that your plan "prefers" and has negotiated a better price for.
What you pay: A higher fixed copay than Tier 2, but less than the next tier.

Tier 4: Even Higher Cost (Non-Preferred Brand Drugs)

What it is: Brand-name or non-preferred generic drugs that your plan covers, but at a higher cost because they haven't negotiated as good of a deal.
What you pay: Usually the first tier where you start paying a coinsurance, which is a percentage of the drug's cost (like 40% or 50%), instead of a flat dollar amount.

Tier 5: Highest Cost (Specialty Drugs)

What it is: Very expensive medications for complex or long-term conditions (like certain cancer drugs or injectables).
What you pay: The highest cost, usually a high coinsurance percentage.

The Main Takeaway:

Lower Tier = Lower Cost for You: A drug in Tier 1 will almost always cost you less than the same drug (or a similar one) in Tier 3.

Plans Choose Tiers: The tricky part is that each Part D plan can put the same drug into a different tier. That's why it's super important to check your specific plan's formulary (drug list) to see where your medications fall and how much you'll owe.

Rose Cahill · Answer

Understanding Medicare drug pricing can be quite challenging. Every company has a Medicare-approved formulary of drugs they offer as part of the Part D prescription drug plan. Those formulary drugs are then grouped into 5 tiers. The lower tiers 1 and 2 contain the most commonly used drugs that have been around for some time and for which there are generic versions. These 2 tiers are the lowest priced drugs for you at the lowest co-pays. Some co-pays may be $0. Tier 3 drugs are comprised of newer drugs - often the drugs you will see advertised on TV. They are more expensive, often have no generic versions and are provided to you at a higher co-pay or co-insurance amount. More commonly, plans are now charging members a co-insurance amount of 20+% at tier 3, which represents a co-pay that is calculated as a per cent of the cost of the drug. Tiers 4 and 5 are specialty drug tiers. Here is where you would find many cancer and chronic care drugs. A good example would be chemo therapy drugs. When you are given a new prescription by your doctor, ask your pharmacist the drug's tier. You may be able to save yourself money by requesting a generic version of the prescribed drug.

Answered by Rose Cahill on September 8, 2025

Agent Licensed in MA

Answered by Rose Cahill Medicare Insurance Agent

Nolan Popel · Answer

There are five different levels for prescriptions. They are called formulary tiers. Tiers one and two are for your preferred generics and non-preferred generics. Tier three and tier four are for your preferred and non-preferred name brands and tier five is for your specialty drugs. The price you will pay will vary by tier. Also, some plans will have a drug deductible that will apply first before the coverage begins for more expensive prescriptions.

Answered by Nolan Popel on July 8, 2025

Agent Licensed in NY, AZ, CA & 15 other states

Answered by Nolan Popel Medicare Insurance Agent

David Moscowitz · Answer

It is based on the expense of the drugs or medications that you have, also if they have an generic alternative at retail pricing.
I.E most prescribed medications are are rated @ tier 1 or 2, whereas a medication like Eliquis is rated @ tier 3 level which is more expensive with a maximum annual out of pocket expense.

Yasmine Lopez · Answer

This can be very confusing for most. Especially as a drug can be a different tier on a different plan. Think of drug tiers like shelves in a store.

The bottom shelf (Tier 1) has the cheapest stuff — mostly common generics, and they usually cost just a few dollars.

The next shelf up (Tier 2) still has generics, but maybe not the preferred ones, so they’re a little more.

Tier 3 and 4 are where you find brand-name drugs — the ones you see on TV. These cost more.

And Tier 5? That’s the top shelf — the really expensive medications for serious conditions, like cancer or autoimmune diseases. Those are the priciest of all.

So the higher the tier, the higher your cost.

That’s why I always check which “shelf” your medications are on before recommending a plan — so we know your drugs on the formulary and what the estimated costs will be. Remember that these are estimates... no agent will be able to dial in exact costs. The tools are not precise enough to offer this as much as I would like to.

Evan Hountz · Answer

Generally , Part D comes with 5 medication tiers. Each plan may tier a medication differently. The higher the tier , the more expensive the medication is priced. In many cases, once a Tier 3 is prescribed , the consumer will be responsible for a drug deductible depending on their plan's benefit.

Answered by Evan Hountz on January 21, 2026

Broker Licensed in OH, FL, IN, KY & TX

Answered by Evan Hountz Medicare Insurance Agent

Jonathan Paddon · Answer

The tiers on your part D plan can be thought of as "copay levels" that each of your medications is assigned to. Many plans have 5 tiers. In general, the higher the tier, the higher the copay you pay at the pharmacy. So, medications assigned to tiers 1 and 2 are usually lower cost medications such as generics. Tiers 3 through 5 are usually more expensive brand name medications. Note that you may have to pay the full cost of your medication until you have met your plan's deductible before you pay the copay corresponding to a particular medication's assigned tier.

Answered by Jonathan Paddon on August 25, 2025

Agent Licensed in TN, AL, FL, GA, IL & MS

Answered by Jonathan Paddon Medicare Insurance Agent

Steven Bleicher · Answer

Most Part D plans exhibit 5 tiers of drugs: 1) Preferred Generic, 2) Non-Preferred Generic,       3) Preferred Brand Name, 4) Non-Preferred Brand Name, and 5) Specialty Drugs. The lowest the tier, the cheaper the copay. 

Tiers are determined by Medicare (CMS) and are based upon the costs of bringing the drug to market (research & development, plus the ingredients). There are some categories of drugs that don't fit into that rule like Insulin ($35.00 apiece) and the ever-escalating costs of various inhalers. 

My tip on paying the least amount of money is to always check with the online discount websites. There are also a number of Canadian online discount pharmacies that are available in order to check their cost to you. Please remember that should you decide to use a Canadian pharmacy, the drug cost will NOT be applied toward the 2025 annual drug deductible (max: $2,000.00). 

Be advised that in 2025, you have 2 options: A) Using your Part D(rug) plan or in checking the drug formulary within your Advantage plan, vs. B) using an online pharmacy which you've investigated and contains a less expensive amount by printing a coupon from your PC. BUT, you cannot use both for the same drug. You CAN use either A or B for the various drugs you take, some of which might point you to your favorite local drug store, while others might dictate that you drive further away from your home to a "different" pharmacy which has better pricing for your drug. The only inconvenience is that you must check that your doctor knows which pharmacy to fax to with each individual drug/Rx.

Timothy Brown · Answer

Typically the lower the tier, the lower the cost.
Listed are the tiers found in most plans:

Tier 1-Preferred Generic: Lisinopril, Atorvastatin and Metformin are a few example.  $0 copay for these prescriptions

Tier 2-Generic: Little to No Copay

Tier 3-Preferred Brand: A deductible may be required in addition to a higher copay. Eliquis, Ozempic and Trulicity are few examples. 

Tier 4-Non Preferred Brand: Same rules apply as Tier 3 but with a higher copay.

Tier 5-Specialty Drugs-Usually has a percentage instead of a copay because of the high cost.

Ron Cronwell · Answer

The tier levels relate to the amount of copy or coinsurance out of pocket cost of a particular prescription. Tier levels may change be different between different plans.

Terry Salak · Answer

Tier 1 and Tier 2 drugs are always the least expensive and are going to be drugs such as, but not limited to, Metformin, Losartan, Amlodipine.  Tier 3 drugs can either have a flat amount associated with them OR, with the changes implemented to the Medicare Prescription Drug Plans during 2025 some plans may require the member to pay a % of the retail cost of the drug.

Tier 4 and Tier 5 drugs are typically paid as a % of the retail cost of the drugs. 

The 2026 MOOP (Maximum Out Of Pocket) is $2,100 and includes the plans annual deductible.  Once this amount is reached by a member then they will not pay for any additional cost associated with prescriptions (with the exception of any monthly premium) for the remainder of the year.

Betty McCarty · Answer

Medicare Part D organizes drugs into tiers (1-5) within a formulary, based on cost. 

Tier 1 includes the lowest-cost generic drugs, while Tier 5 covers high-cost specialty medications. Monthly premiums and drug deductibles vary by plan, with some offering no monthly premiums.

If you would like additional information or have further questions, please feel free to contact us.

Satoshi Aoki · Answer

Each prescription drug has a tier, and the amount you have to pay out of pocket varies depending on the type of drug.

Example:

TIER 1: Preferred Generic
TIER 2: Other Generic
TEAR 3: Preferred brand
TEAR 4: Brand
Special: Special

If you already have a Part D plan, we recommend you check with your insurance company or agent to find out what tier the drug you are taking is.

Tammie Rutledge · Answer

Tier 1 and Tier 2 are Generic brands 
Tier 3 are Brand Name 
Tier 4 are specialty drugs   
Each tier has a copay associated with it.  Tiers 3 and 4 will trigger the annual deductible to be satisfied. Ask your representative for a breakdown of your Drug Plan.

D. Scott Harrod · Answer

Most Part D drug Plans will have either 5 or 6 Tiers, Tier 1 and often Tier 2 you will find generic drugs and their copays will be the the lowest or even no cost of the 5 or 6 Tiers. Not all, but most Plans have a Deductible, not all Plans and in most Plans the Deductible will be triggered and add to Your costs, additionally Tier 3 and above Drugs are usually Brand Name and higher copay cost drugs as well

Answered by D. Scott Harrod on October 11, 2025

Agent Licensed in KY

Answered by D. Scott Harrod Medicare Insurance Agent

Nickey Baxter · Answer

Hello. The tiers are designed to separate prescriptions by name brand or generic, and cost. They also vary by the prescription, if it has no generic equivalent. In general, Tier 1 and 2 are very common medications, that many people are prescribed. These tiers often have no deductible (what you must pay before a company begins to pay) or low copays. The higher the tier, generally, the more out of pocket expenses you will have.

Answered by Nickey Baxter on October 15, 2025

Broker Licensed in UT, AZ, CO & 18 other states

Answered by Nickey Baxter Medicare Insurance Agent

Anabelle Paghiligan-Wall · Answer

Hi. Tier 1 has lowest copayment. Mostly generic drugs. Tier 2 has medium copayment. Mostly generic too. Tier 3 has higher copayment, non-prefereed brand name drugs, specialty toer has the highest copayment, very high priced medications. Also for 2026, drug plans have 3 stages: Deductble stage ( $615), Initial stage coverage stage after you reached the $615 deductible , you will pay 25% of the coast of coinsurance drugs until out of pocket cost reached $2100(2026) after that you will be in Catastrophic stage wherein you do not have to pay out of pocket for covered part D for the rest of the year. But of course, it depends on what type plan do you have. This is the general information of tiers and drug coverage stages. Thank you.

Answered by Anabelle Paghiligan-Wall on October 18, 2025

Broker Licensed in NE, CA, FL & 8 other states

Answered by Anabelle Paghiligan-Wall Medicare Insurance Agent

Fred Manas · Answer

In summary, the tier your medication is placed on in your Part D plan significantly impacts your out-of-pocket costs. Lower tiers generally mean lower copays, while higher tiers can lead to higher costs.

Answered by Fred Manas on April 21, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent

Gary Henderson · Answer

That is too difficult to explain easily in a short paragraph. So give me a call and we'll look at your plan and other plans to see what would be the best fit for you

Carol Thompson · Answer

Depending on what plan you are on , each plan has tiers in the their formulary of the Part D.. usually the higher the Tier the higher the cost of medications. again that varies on your plan, service area (like state, county and zip code.) Very important to be aware of the tiers your medications will fall into, so that you know the cost or co-pays.

Answered by Carol Thompson on October 8, 2025

Broker Licensed in FL, LA, MI & NC, SC, VA & WI

Answered by Carol Thompson Medicare Insurance Agent

Carol Conner · Answer

Anything that’s a tier 3 and up is going to be more for a specific type of condition and involves higher costs but once you meet your deductible then the plan will pay the remaining time of your annual contract

Answered by Carol Conner on November 23, 2025

Broker Licensed in TX

Answered by Carol Conner Medicare Insurance Agent

Brent Mowery · Answer

Good question! Medicare Part D (Rx) Plans put all medications on their offering of covered medications (formulary) into tiers or levels of consumer copays. 

Typically, the lower the average retail pharmacy cost, the lower the tier or copay level. A generic medication will have a lower pharmacy cost versus a name brand medication with a higher retail cost. 

When looking for a Part D (Rx) Plan, contact a licensed l, experienced broker that can assist you in your choices. I have 25 years of experience and would love to answer your questions. Thanks!

Jim Willis · Answer

Medication’s fall into several tiers, depending on the age, commonality, patents, etc.  most common medication’s, like blood pressure, meds, statins, antibiotics, and some COPD and asthma drugs, generally fall into tier one or tier 2 and will likely have very low or no co-pays. 

Newer drugs, biologics and some drugs popular due to their use and success rate will generally be priced in tiers three or tier 4 and have co-pays ranging from $40 to several hundred dollars.  You may be able to get a tier exception from the drug plan working with your doctor that can drop a co-pay several hundred dollars.

John Messler · Answer

This is part of the fact gather gathering before enrollment. It’s important to collect a list of all the prescriptions used by the senior and see how they fit into the different plans. We can find out if they are on or off formulary and or what tier they fall under. For example, tears one and two are typically, generic and lower cost with lower co-pays while tears 34 and five are often a larger cost share. This is very important when comparing plans do not only consider the premium but the out-of-pocket each month for their prescriptions.

Answered by John Messler on September 30, 2025

Agent Licensed in NH, ME, NC, OH, PA & TX

Answered by John Messler Medicare Insurance Agent

Dominic Javier · Answer

Medicare Part D provides prescription drug coverage through private insurance plans, and these plans often have a tiered pricing system for medications. The tier structure can significantly affect your out-of-pocket costs for prescriptions.

Answered by Dominic Javier on November 14, 2025

Broker Licensed in TX

Answered by Dominic Javier Medicare Insurance Agent

Adam Paul · Answer

The different tiers and Medicare Part D plans affect what you pay for medications, since each medication can fall into a different tier. Depending on what tier they fall under, that will determine how much you pay for a given prescription medication.

Answered by Adam Paul on October 26, 2025

Broker Licensed in CA, NV, OK & OR

Answered by Adam Paul Medicare Insurance Agent

Otisha Newton · Answer

That’s a great question — and you’re not alone. The tiers in Medicare Part D plans can definitely be confusing, but once you understand how they work, it makes your prescription costs much easier to predict.

Here’s the breakdown:

Every Medicare Part D plan has a formulary — basically a list of covered drugs — and those drugs are divided into tiers. Each tier has a different cost level (copay or coinsurance). The lower the tier, the less you pay.

Here’s a general idea of how most plans structure it:

Tier 1: Preferred generics — lowest copay (often $0 to $5)

Tier 2: Non-preferred generics — slightly higher copay

Tier 3: Preferred brand-name drugs — moderate cost

Tier 4: Non-preferred brand-name drugs — higher cost

Tier 5 (or Specialty Tier): Very high-cost or specialty medications — you’ll usually pay a percentage (coinsurance) rather than a flat copay

The main thing to remember is that the same drug can be on different tiers in different plans, so what you pay depends on your plan’s specific formulary.

When helping clients, I always review their current prescriptions and compare how each plan covers them — because the tier placement can make a huge difference in what you pay at the pharmacy each month.

Would you like me to show you how to check what tier your medications are on in your current plan?

Ross Landon · Answer

There is always a Benefit Summary that shows you exactly what you will pay, depending upon what Tier the drug has been assigned!  You can look those up online at the Carrier’s website under Formulary lists, or you can call the Customer support # on the back of your card & they will help you know the right Tier.  

Then just look up the Tier # on your Benefit Summary,  & it will tell you the copay $ amount, or the Co-insurance % amount that you will pay for that Prescription!

Mike Wetsel · Answer

Tiers 1 & 2 are typically generic drugs. They are usually zero or low cost to you and they do not go toward your annual deductible.
Tiers 3, 4 and 5 are typically brand name and specialty drugs. They cost more and the retail cost of the drug goes toward your annual deductible.
Drug changes within these tiers are one reason the ANOC and RX review is so important.
This protects you from unexpected high prescription drug costs.

Shahnaz Razvi · Answer

Most Part D plans have 5 or 6 tiers. The first 2 tiers are for generic drugs.

The tiers 3,4 and 5 are not generic and are usually branded drugs that tend to be more expensive than the lower tiers.

Darnel Brown · Answer

The tiers in a RX plan can be confusing . 

Usually tiers 1 and tiers 2 are your generic medications such as blood pressure 
Then tier 3 are brand drugs Ozempic and some preferred generics
Tier 4 &5 are high cost special drugs
It is always wise to verify your drugs before enrollment in a plan.
Each Company has a different formulary which drug tier can very. 
Meaning could cost more due to tier classification of a particular medication

Mary Rivera · Answer

Lower tiers, like generics, usually have lower copays, while higher tiers, like brand name or specialty drugs, cost more. 
The tier your medication is in determines your share of the cost, so checking the plan’s formulary is very important.

Donald Heath · Answer

The part D Medicare drug plan tiers in 2025 run from Tier 1- preferred generics to Tier 2- non preferred generics to Tier 3- preferred brand name to Tier 4- non preferred brand name to (sometimes) Tier 5- specialty or compounded meds.

Tier 1 and 2 are typically not subject to the annual part D drug deductible of $590 in 2025.  Part D medication costs are capped at $2000 for the calendar year including the $590 deductible and all co-pays and co-insurance.   This is new for 2025 under the Inflation Reduction Act passed in 2022.

Veda Prabha Srinivas · Answer

Medicare Part D Tiers is about different kind of drugs is included in different tiers. Important is that you should check your medications are in which tiers, according to that the payment changes.

Kathleen Emert · Answer

Good Afternoon,

There are 5 Tiers for Prescriptions within Medicare Plans.  Starting with Tier 1 being the least expensive. 

Each Carrier has a different formulary for how they classify a prescription in what Tier and how much your monthly copay would be for that prescription. Additionally if the drug is classified as a Tier 3 - Tier 5 it may also have an annual deductable amount assoicated with it.

If you are required to pay an annual deductible you only pay it once a year regardless of how many T3 - T5 scripts you are on.  

Therefore, prescription drug costs vary by Carrier and  plans.  It is very important to provide all of you prescription drug information to a representative so they can research your best options.  Or you can research this information yourself through the  CMS website.

Typically the costs in NY for 2025 are something like this:

Tier 1 - Preferred Generic (often no $0 monthly copay)
Tier 2 - Generic (range from $10 to $20 monthly copay)
Tier 3 - Preferred Brand Name Drugs (range from $42 - $47 monthly copay)  and an annual deductible may apply
Tier 4 - Non-Preferred Drugs (your copay maybe a flat $ for a % of the drug cost (coinsurance) and an annual deductibe may aply
Tier 5 - Specialty Drugs (your copay will most likely be a % of the drug cost) and an annual deductible may apply.

Keep in mind most of the carriers have direct mail order services which typically offer you the ability to pay two months of copayments for a 90-day supply.

I hope this helps clarify your confusion.

Sheila Trumble · Answer

There are 5 Drig tiers. Tier 1 Tier 2 Tier 3 Tier 4 Tier 5. Tier 1 Generic Tier 2 Preferred generic - they usually have a $0 to $18 copay depending on each carriers formulary. Tier 3-5 have a %cost of the total cost of the drug for a copay. Every carriers formulary has a different formulary of these ties with the copay. When meeting to discuss prescriptions this can s entered into the carriers formulary further defining the copay cost.

Answered by Sheila Trumble on November 22, 2025

Agent Licensed in OH, NY & PA

Answered by Sheila Trumble Medicare Insurance Agent

I'm confused about the different tiers in Medicare Part D plans. How do they affect what I pay for my medications?

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