Five-Tier Benefits Overview
When possible, consider filling your prescription with a generic rather than a brand name drug.
Horizon BCBS is committed to providing members with access to the right care, including safe and effective medications. Members in an RWJBarnabas Health plan have a five-tier prescription drug benefit, which means there are five levels of pricing based on certain criteria, including whether the medication is generic. This tier structure provides you with cost-effective treatment options when possible.
Covered medications fall into one of the following tiers:
Tier One: Generic
Generics contain the same active ingredients and are available in the same strengths and dosages as their brand name equivalent. Generics cost less than brand name drugs and can save you money.
Tier Two: Preferred Brand
Preferred brand is a medicine that has been identified as a good value, both clinically and financially. You pay less for Preferred brand name drugs than for non-Preferred brand name drugs.
Tier Three: Non-Preferred Brand
A non-Preferred brand name drug is a medication that has an alternative generic or Preferred brand name drug that is clinically equivalent. These medicines typically cost more than generic and Preferred brand name drugs.
Tier Four: Preferred Specialty
This category includes high-cost prescription medications used to treat complex, chronic conditions. Specialty medicines often require special handling (like refrigeration during shipping) and administration (such as injection). They also are limited to a 30-day supply at a time and must be filled through LSC. Specialty medicines may be generic, Preferred brand or non-Preferred brand.
Tier Five: Non-Preferred Specialty
These specialty drugs can be generic or brand-name and often have preferred specialty drug alternatives.