What are drug tiers in Medicare plans?

• A. They categorize medications; higher tiers generally have higher copays/coinsurance
• B. They describe the order in which drugs must be prescribed
• C. They determine the exact pharmacies you can use
• D. They set statewide drug pricing for all plans

Answer: (A)

Drug tiers categorize medications within a Medicare Part D plan’s formulary, assigning each drug to a level that determines your cost share. As the tier number rises, your out-of-pocket costs typically rise as well, with generics often on the lowest tier at small fixed copays, and more expensive brand-name or specialty drugs on higher tiers with higher copays or coinsurance. This structure helps you compare plans and anticipate what you’ll pay before filling prescriptions. It isn’t about prescribing order, it doesn’t set which pharmacies you can use (that’s about the plan’s network), and it doesn’t set statewide drug prices across plans.