Formularies

For coverage dates starting 01/01/2020, please refer to the following links:

Formulary Tier Structure

3-Tier Pharmacy Copayment Program

Tufts Health Plan has adopted a three-tiered approach to the cost of prescription drugs in order to provide members with choice and affordable options when it comes to prescription drugs.

All covered drugs are divided into three tiers. Providers have the option to write a prescription for a Tier-1, Tier-2 or Tier-3 drug (as defined below). Tufts Health Plan realizes there may be instances when only a Tier-3 drug is appropriate, which will require a higher copayment from the member.

Note: Tiers are subject to change throughout the year.

The 3-Tier Copayment Program places all covered prescriptions into one of the following tiers:

  • Tier-1: Medications on this tier have the lowest cost sharing amount
  • Tier-2: Medications on this tier have a higher cost sharing amount
  • Tier-3: This is the highest copayment tier have the highest cost sharing amount

Note for Rhode Island Formularies: Infertility drugs are not included in the 3-Tier copayment program for Rhode Island formularies. Members who receive prior authorization for coverage of infertility drugs will pay a 20% coinsurance for each drug they utilize.

4-Tier Pharmacy Copayment Program

If the member’s plan includes a 4-Tier Copayment design, all covered drugs are divided into four tiers. Providers have the option to write a prescription for a Tier-1, Tier-2, Tier-3, or Tier-4 drug (as defined below). Tufts Health Plan realizes there may be instances when only a Tier-4 drug is appropriate, which will require a higher copayment from the member.

The 4-Tier Copayment Program places all covered prescriptions into one of the following tiers:

  • Tier 1: Medications on this tier have the lowest cost sharing amount
  • Tier 2: Medications on this tier have a higher cost sharing amount
  • Tier 3: Medications on this tier have a higher cost sharing amount
  • Tier 4: Medications on this tier have the highest cost sharing amount; limited to a 30- day supply

Note for Rhode Island formularies: Infertility drugs are not included in the 4-Tier copayment program for Rhode Island formularies. Members who receive prior authorization for coverage of infertility drugs will pay a 20% coinsurance for each drug they utilize.