What is the tier structure for all standalone PDP formularies in 2022?

The tier structure for standalone Prescription Drug Plans (PDP) in 2022 is a three-tier structure. This structure is commonly utilized to categorize medications based on cost-sharing levels and clinical criteria.

In a three-tier formulary, the first tier typically comprises generic medications, which have lower co-pays. The second tier includes preferred brand-name drugs that tend to have higher co-pays than generics, representing a balance of cost-effectiveness and drug efficacy. The third tier usually consists of non-preferred brand-name drugs and specialty medications, which come with higher co-pays due to their higher associated costs.

This tiered approach is designed to encourage the use of more cost-effective medications while still providing access to necessary treatments. Such structures help manage costs for both plans and beneficiaries while ensuring a variety of options for patient care.