CY2018 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

Proposed 2018 Tier Labels and Hierarchy
Non-Defined Standard Part D Plans
2018 Tier
Structure
2 Tiers

2018 Option

Tier 1

Tier 2

Tier 3

Tier 4

Tier 5

Tier 6

A

Generic

--­

--­

--­

--­

2 Tiers

B

Generic

Brand
Preferred
Brand

--­

--­

--­

--­

3 Tiers

A

Generic

Brand

Specialty Tier

--­

--­

--­

3 Tiers

B

Generic

Preferred
Brand

Specialty Tier

--­

--­

--­

3 Tiers

C

Generic

Preferred
Brand

--­

--­

--­

3 Tiers

D

Preferred
Generic

Preferred
Brand

--­

--­

--­

3 Tiers

E

Generic

Preferred
Brand

--­

--­

--­

4 Tiers

A

Generic

Preferred
Brand

Specialty Tier

Optional *

--­

4 Tiers

B

Preferred
Generic

Generic

NonPreferred
Brand

Optional *

--­

4 Tiers

C

Preferred
Generic

Generic

Specialty Tier

Optional *

--­

4 Tiers

D

Generic

Preferred
Brand

Injectable
Drugs

Optional *

--­

4 Tiers

E

Preferred
Generic

Preferred
Brand

Specialty Tier

Optional *

--­

4 Tiers

F

Preferred
Generic

Preferred
Brand

Injectable
Drugs

Optional *

--­

4 Tiers

G

Preferred
Generic

Generic

Preferred
Brand

Optional *

--­

5 Tiers

A

Preferred
Generic

Generic

Preferred
Brand

Specialty Tier

Optional *

5 Tiers

B

Preferred
Generic

Generic

Preferred
Brand

Injectable
Drugs

Optional *

5 Tiers

C

Preferred
Generic

Generic

Specialty Tier

Optional *

5 Tiers

D

Generic

Preferred
Brand

Injectable
Drugs

Specialty Tier

Optional *

5 Tiers

E

Preferred
Generic

Preferred
Brand

Injectable
Drugs

Specialty Tier

Optional *

NonPreferred
Brand
NonPreferred
Drug
NonPreferred
Drug
NonPreferred
Brand
Preferred
Brand
Preferred
Brand
NonPreferred
Brand
NonPreferred
Drug
NonPreferred
Drug

Preferred
Brand
NonPreferred
Brand
NonPreferred
Drug

NonPreferred
Drug
NonPreferred
Brand
NonPreferred
Brand
Injectable
Drugs

NEW

2018 Tier
Structure

2018 Option

Tier 1

Tier 2

Tier 3

Tier 4

Tier 5

Tier 6

NonPreferred Specialty Tier Optional *
Drug
NonInjectable
Preferred
Preferred
5 Tiers
G
Optional *
Generic
Preferred
Drugs
Generic
Brand
Drug
NonInjectable
Preferred
Preferred
6 Tiers
A
Specialty Tier
Generic
Preferred
Drugs
Generic
Brand
Brand
NonInjectable
Preferred
Preferred
6 Tiers
B
Generic
Preferred Specialty Tier
Drugs
Generic
Brand
Brand
NonInjectable
Preferred
Preferred
Specialty Tier
6 Tiers
C
Generic
Preferred
Drugs
Generic
Brand
Drug
NonInjectable
Preferred
Preferred
6 Tiers
D
Generic
Preferred Specialty Tier
Drugs
Generic
Brand
Drug
th
th
*The optional 5 or 6 tier can be used as an excluded-drug-only tier or for other meaningful offerings such as a $0
5 Tiers

F

Preferred
Generic

Generic

Preferred
Brand

NEW

NEW

NEW