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 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.