CareFirst BlueCross BlueShield offers convenient and affordable prescription drug plans with a nationwide network of over 60,000 pharmacies. Learn more about our plans and our Formulary (drug list) structure.
A formulary is a list of covered prescription drugs. Our drug list is reviewed and approved by an independent national committee comprised of physicians, pharmacists and other health care professionals who make sure the drugs on the formulary are safe and clinically effective.
Within the formulary, prescription drugs are divided into tiers. Depending on your plan, prescription drugs fall into one of five drug tiers which determines the price you pay. Some plans may have 3, 4 or 5 tiers, so be sure to check your benefits information to see which tiers are included.
5-tier drug plan
Drug Tier (cost-share)Definition
Tier 0$0 Drugs
Preventive drugs (e.g. statins, aspirin, folic acid, fluoride, iron supplements, smoking cessation products and FDA-approved contraceptives for women) are available at a zero-dollar cost share if prescribed under certain medical criteria by your doctor. Oral chemotherapy drugs and diabetic supplies (e.g. insulin syringes, pen needles, lancets, test strips, and alcohol swabs) are also available at a zero-dollar cost share.
Tier 1Generic Drugs$
Generic drugs are the same as brand-name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Generic drugs generally cost less than brand-name drugs.
Tier 2Preferred Brand Drugs$$
Preferred brand drugs are brand-name drugs that may not be available in generic form, but are chosen for their cost effectiveness compared to alternatives. Your cost-share will be more than generics but less than non-preferred brand drugs. If a generic drug becomes available, the preferred brand drug may be moved to the non-preferred brand category.
Tier 3Non-Preferred Brand Drugs$$$
Non-preferred brand drugs often have a generic or preferred brand drug option where your cost-share will be lower.
Tier 4Preferred Specialty Drugs$$$$
Preferred specialty brand drugs are specialty brand-name drugs that may not be available in generic form but are chosen for their cost effectiveness compared to alternatives. Your cost-share will be more than generics but less than non-preferred specialty brand drugs. If a generic drug becomes available, the preferred specialty brand drug may be moved to the non-preferred specialty brand category.
Tier 5Non-Preferred Specialty Drugs$$$$$
Non-preferred specialty drugs often have a specialty drug option where your cost-share will be lower.
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