Premera members have many different drug benefit options with our plans. You pay a designated copay or coinsurance, depending on the “tier” the drug is assigned to. If you’re not sure what prescription coverage you have, or if you have a different benefit than what is shown here, log into Premera.com, check your benefits booklet for complete details or contact Customer Service.
Check your ID card to see your copay or coinsurance for each drug tier.
The sample card here may not match what appears on your card, as benefits differ by plan.
Use Rx Search to find your medication’s drug tier.
With a four-tier drug benefit, your prescription medications fall into one of four categories or “tiers.” Each tier has a different copay or coinsurance.
Lowest cost. Generic drugs are as effective, safe and high quality as their brand-name counterparts, yet less expensive.
Learn more about generic drugs
Copay or coinsurance
Moderate cost. Considered “preferred” when there is no generic, and because of their value and effectiveness.
Often have Tier 1 or Tier 2 alternatives. These drugs may be more expensive than their alternatives in Tier 1 or Tier 2. Also includes new drugs not yet reviewed for their safety and effectiveness.
Considered “preferred” when there is no generic, and because of their value and effectiveness.
A single-tier drug benefit is usually part of a major medical or HSA-qualified high deductible health plan.
If you have a plan with a single coinsurance, it usually has an upfront combined medical and pharmacy deductible. Once you meet your deductible, you will pay a flat coinsurance for the remainder of the year for your medications.
Use Rx Search to see if your drug is covered or excluded.
*Drugs are placed into each tier based on decisions made by our Pharmacy and Therapeutics (P&T) Committee. This team of community doctors and pharmacists meets regularly to collaboratively review the most current medical studies and make updates to our Preferred Drug List.
The Select Drug List is a four tier benefit that provides access to essential drugs, but does not cover medications that are available over-the-counter or brand-name drugs that have generic alternatives. Examples of excluded drug classes would be cough and cold, antihistamine and heartburn/acid reflux medicines.
Our preventive drug benefits are HSA-qualified and provide full coverage to ensure that you have access to those medications that are determined to help keep your condition from getting worse. Deductibles, copays or coinsurances are waived for certain generic medications that treat cardiovascular disease and diabetes.
Consult the HSA Generic Preventive Drug List to see if your drug is included in this benefit.
With a Value-Based Drug Benefit, your prescription medications fall into one of four categories or “tiers.” Each tier has a different copay or coinsurance. Under the Value-Based Drug Benefit, medications are categorized by tier based on their quality, value and effectiveness—not by their generic, brand-name or specialty drug label. So, for this benefit each tier may contain a combination of generic, brand-name and specialty drugs.
Who decides a drug’s value?
A drug’s value is based on science. An independent set of experts made up of leading physicians, pharmacists, health economists, a bioethicist, and a member representative review new and existing drugs. The drugs are evaluated on how well they work relative to their cost and how their effectiveness compares to similar drugs used to treat the same condition.