Medicare Part D Formulary Tiers

The brand name and generic drugs included in the SilverScript formularies are categorized into cost-sharing tiers that are numbered from 1 to 5. SilverScript Medicare Part D formulary tiers indicate the level of cost-sharing for a covered drug. SilverScript plans use a system with five Medicare formulary tiers. In general, the higher the tier, the higher the member’s out-of-pocket cost for the covered drug.

Cost-Sharing Tier 1: Preferred Generic
Tier 1 is the lowest tier. Low cost preferred generic drugs are included in this tier.

Cost-Sharing Tier 2: Generic
Tier 2 includes preferred generic drugs.

Cost-Sharing Tier 3: Preferred Brand
Tier 3 includes preferred brand drugs and non-preferred generic drugs.

Cost-Sharing Tier 4: Non-Preferred Drug
Tier 4 includes non-preferred brand drugs and non-preferred generic drugs.

Cost-Sharing Tier 5: Specialty Tier
Tier 5 is the highest tier. It contains very high cost brand and generic drugs, which may require special handling and/or close monitoring.

Helpful Links on Medicare Formulary Tiers: