A list of prescription drugs covered by a health insurance plan, organized into tiers based on cost. Generic drugs are typically on the lowest-cost tier, while brand-name and specialty drugs are on higher tiers with larger copays or coinsurance.
Related Terms
Coinsurance
The percentage of costs you share with your insurer after meeting your deductible. For example, with 80/20 coinsurance, the insurer pays 80% of covered expenses and you pay 20% until you reach your out-of-pocket maximum.
Copay
A fixed dollar amount you pay for a covered health care service at the time you receive it. For example, you might pay a $30 copay for a doctor visit regardless of the total bill. Copays do not usually count toward your deductible but often count toward your out-of-pocket maximum.
Pre-Authorization
Approval from your health insurer that must be obtained before certain medical services, procedures, or medications are provided. Also called prior authorization, failing to get it when required can result in the insurer denying the claim or paying a reduced amount.