How Rx Benefits Work

While prescription benefits vary in design, some basic elements remain the same regardless of the specific copay or coinsurance amount. The price your patient pays depends on the choice made when you help them select a medication.

To help you understand how prescription benefits work, we’ve outlined three of the most commonly purchased plans.

Three-Tier Rx Benefits
A three-tier prescription benefit gives you choice over which medications you use while also balancing costs. To do this, the benefit breaks prescription medications into three categories, or tiers. Learn more.>>

Open Rx Benefits
An open prescription benefit gives you choice over which medications you use but does not attempt to balance costs or reduce trend. The benefit may or may not break prescription medications into two categories, or tiers. Learn more.>>

Closed Rx Benefits
A closed prescription benefit is designed to be simple to use, keep your out-of-pocket expense low and control costs by pointing both you and your healthcare provider to clinically sound and cost-effective medications. To do this, the benefit breaks prescription medications into two categories, or tiers. Learn more.>>