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Rocco DeLuca — Vernal Medicare

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By Rocco DeLuca, Licensed Insurance Agent • Published 2026-04-04 • Last updated 2026-04-04

Tier 3 vs Tier 4 Drugs on Medicare Part D — Explained

When reviewing Part D plans, you will see drugs assigned to tiers. The tier determines your copay or coinsurance. Understanding how tiers work helps you choose a plan that covers your medications at the lowest cost.

How Part D Tiers Work

Most Part D plans use a 5-tier structure. Tier 1 (Preferred Generic): Lowest cost — $0 to $5 copay. Common generics like metformin, lisinopril, amlodipine. Tier 2 (Generic): Low cost — $5 to $15 copay. Less common generics. Tier 3 (Preferred Brand): Moderate cost — $30 to $50 copay or 25% coinsurance. Brand-name drugs the plan prefers. Tier 4 (Non-Preferred Brand): Higher cost — $80 to $150+ copay or 40–50% coinsurance. Brand drugs the plan does not prefer. Tier 5 (Specialty): Highest cost — 25–33% coinsurance. Specialty drugs often requiring special handling.

Why the Same Drug Can Be Different Tiers

Each Part D plan negotiates its own pricing with drug manufacturers. A medication on Tier 3 with one plan may be Tier 4 (or even Tier 2) with another. This is exactly why comparing plans based on your specific medications matters — the tier assignment determines your cost.

How to Lower Your Tier Costs

Ask your doctor about generic alternatives (Tier 1 or 2 instead of brand). Compare plans — your drug might be Tier 3 on one plan and Tier 4 on another. Check if a 90-day supply by mail order reduces per-unit cost. Apply for Extra Help if income-eligible — it dramatically reduces copays regardless of tier. Remember the $2,000 annual cap — after reaching it, all tiers cost $0.

Related: Best Part D plans in Vernal | Cheapest drug plans | Ozempic/Wegovy coverage

Source: Medicare.gov.

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Call Rocco: 435-219-5120 (TTY: 711) • [email protected]