Pharmacy Programs

All you need to know about our pharmacy programs


Tiered pharmacy programs

Check with your employer to determine which pharmacy program your plan uses.

3-Tier Pharmacy Copayment Program

Prescription drug prices vary tremendously - including drugs used to treat the same condition. We sort prescription drugs into three tiers to help you and your doctor choose the most cost-effective option for the medication you need. Each tier has a specific copay amount that you pay when you fill or order your prescription.

  • If your doctor prescribes a Tier-3 drug, you can work with him or her to determine if there is an appropriate drug available that will be less costly.
  • Depending on your plan, coverage for prescription drugs may be subject to an annual deductible amount or be limited to our generic-focused drug list.
  • Tier placement is subject to change throughout the year.

Tier descriptions

Tier 1 - Lowest copayment
Medications on this tier have the lowest copayment. This tier includes many generic drugs.

Tier 2 - Middle copayment
Medications on this tier are subject to the middle copayment. This tier includes some generics and brand-name drugs.

Tier 3 - Highest copayment
This is the highest copayment tier and includes some generics and brand-name covered drugs not selected for Tier 2.

4-Tier Pharmacy Copayment Program - Massachusetts

Prescription drug prices vary tremendously - including drugs used to treat the same condition. We sort prescription drugs into four tiers to help you and your doctor choose the most cost-effective option for the medication you need. Each tier has a specific copay amount that you pay when you fill or order your prescription.

  • For Massachusetts employer-based plans the 4-Tier Copayment Program features a specialty tier for drugs included in and obtained through the designated specialty pharmacy (SP) program.
  • Drugs that are part of the SP program include but are not limited to medications used in the treatment of rare diseases, infertility, hepatitis C, growth hormone deficiency, multiple sclerosis, rheumatoid arthritis, and cancers treated with oral medications.
  • A complete list of specialty drugs included in the SP program and subject to the specialty tier is available on the Tufts Health Plan web site.
  • Depending on your plan, coverage for prescription drugs may be subject to an annual deductible amount or be limited to our generic-focused drug list.
  • Tier placement is subject to change throughout the year.

Tier descriptions

Tier 1 - Lowest copayment
Medications on this tier have the lowest copayment. This tier includes many generic drugs.

Tier 2 - Lower copayment or coinsurance
Medications on this tier are subject to a lower copayment or coinsurance. This tier includes some generics and brand-name drugs.

Tier 3 - Higher copayment or coinsurance
Medications on this tier are subject to a higher copayment or coinsurance. This tier includes some generics and brand-name covered drugs not selected for Tier 2.

Tier 4 - Highest copayment or coinsurance
This is the highest copayment or coinsurance tier and includes brand-name covered specialty drugs included in the Specialty Pharmacy program.

4-Tier Pharmacy Copayment Program - Rhode Island

Prescription drug prices vary tremendously - including drugs used to treat the same condition. We sort prescription drugs into four tiers to help you and your doctor choose the most cost-effective option for the medication you need. Each tier has a specific copay amount that you pay when you fill or order your prescription.

  • For Rhode Island employer-based plans the 4-Tier Copayment Program features a specialty tier for high-cost specialty, self-injectable and biotech drugs.
  • Drugs subject to the specialty tier include but are not limited to medications used in the treatment of rare diseases, hepatitis C, growth hormone deficiency, multiple sclerosis, rheumatoid arthritis, and cancers treated with oral medications.
  • Infertility drugs are not included in our 4-Tier copayment program for Rhode Island members. Members who receive prior authorization for coverage of infertility drugs will pay a 20% coinsurance for each drug they utilize
  • A complete list of drugs included in the specialty tier is available on the Tufts Health Plan web site.
  • Depending on your plan, coverage for prescription drugs may be subject to an annual deductible amount or be limited to our generic-focused drug list.
  • Tier placement is subject to change throughout the year.

Tier descriptions

Tier 1 - Lowest copayment
Medications on this tier have the lowest copayment. This tier includes many generic drugs.

Tier 2 - Lower copayment or coinsurance
Medications on this tier are subject to a lower copayment or coinsurance. This tier includes some generics and brand-name drugs.

Tier 3 - Higher copayment or coinsurance
Medications on this tier are subject to a higher copayment or coinsurance. This tier includes some generics and brand-name covered drugs not selected for Tier 2.

Tier 4 - Highest copayment or coinsurance
This is the highest copayment or coinsurance tier and includes brand-name covered specialty drugs.


Mail-order pharmacy program

Here’s how to get started with the CVS Caremark mail-order pharmacy service:

  • Be sure you have any necessary approvals in place.
  • Call CVS Caremark Customer Service toll free at 1-800-581-5300. If your medication does not need an approval, you will be transferred to CVS Caremark’s FastStartSM service, which will get you started with the mail-order service. You will need the following when you make the call:
    • Your Tufts Health Plan ID card
    • Medication name
    • Your physician’s name and phone number
    • Shipping address
    • Credit card information and expiration date

Once you begin receiving medications by mail, you can order refills easily online or by phone.