Which statement about prescription drug cost-sharing is false?

• A. Higher-tier drugs generally incur higher copays or coinsurance.
• B. Lower-tier drugs generally cost less.
• C. Some formulary plans waive cost-sharing for certain generics.
• D. All tiers always require the same copay.

Answer: (D)

Prescription drug cost-sharing is designed around tiered formularies. Drugs are grouped into tiers, and each tier has a different out-of-pocket amount. Lower-tier options, especially generics, typically have small copays or even no cost-sharing, while higher-tier options, such as many brand-name drugs, usually involve higher copays or coinsurance. Some plans also waive or reduce cost-sharing for certain generics to encourage their use. Because of these variations, it’s not true that every tier requires the same copay. The amount members pay can differ across tiers and plans, and there can be exceptions like zero-cost generics or coinsurance in certain circumstances.