How do drug tiers affect member cost-sharing?

• A. Tiers do not affect cost-sharing.
• B. Higher tiers generally have lower copays/coinsurance; lower tiers cost more.
• C. Higher tiers generally have higher copays/coinsurance; lower tiers cost less.
• D. Only deductibles change with tiers.

Answer: (C)

Drug tiers are levels that group medications by value and cost to the plan. Each tier carries a different amount of cost-sharing, and that amount typically goes up as you move to higher tiers. So, Tier 1 (often generics) usually comes with the lowest copay or coinsurance, Tier 2 (preferred brands) with higher cost-sharing, and Tier 3 (non-preferred brands or specialty meds) with the highest. This structure is designed to steer members toward cheaper, higher-value options while still covering more expensive medications with greater out-of-pocket costs. Deductibles aren’t what tiering primarily changes; the key effect is on copays and coinsurance across tiers. That’s why the statement that higher tiers generally have higher copays/coinsurance and lower tiers cost less is the best description.