`
`Copayment Tier Definitions
`
`Medications are assigned to one of four, five or six categories known as copayment or coinsurance tiers,
`based on drug usage, cost and clinical effectiveness. Our prescription drug search can show you which tier
`applies to a specific medication based on your benefits plan.
`
`Copayment Definitions for the Four-Tier Formulary
`Tier 1 - The prescription drug tier which consists of the lowest cost tier of prescriptions drugs, most are
`generic.
`
`Tier 2 - The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and
`some brand-name prescription drugs.
`
`Tier 3 - The prescription drug tier which consists of higher-cost prescription drugs, most are brand-name
`prescription drugs, and some are specialty drugs.
`
`Tier 4 - The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty
`drugs.
`
`Copayment Definitions for the Five-Tier Formularies
`Tier 1 - The prescription drug tier which consists of the lowest cost tier of prescription drugs, most are generic.
`
`Tier 2 - The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and
`some brand name prescription drugs.
`
`Tier 3 - The prescription drug tier which consists of high-cost prescription drugs, most are brand-name
`prescription drugs.
`
`Tier 4 - The prescription drug tier which consists of the higher-cost prescription drugs, most are brand-name
`prescription drugs, and some specialty drugs.
`
`Tier 5 - The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty
`drugs.
`
`Copayment Definitions for the Six-Tier Formularies
`Tier 1 - The prescription drug tier which consists of the lowest cost tier of prescription drugs, most are generic.
`
`Tier 2 - The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and
`some brand name prescription drugs.
`
`Tier 3 - The prescription drug tier which consists of high-cost prescription drugs, most are brand-name
`prescription drugs.
`
`http://www.bcbsnc.com/content/services/formulary/rxdef.htm
`
`MYLAN - EXHIBIT 1114
`Mylan Pharmaceuticals Inc. et al. v. Allergan, Inc.
`IPR2016-01127, -01128, -01129, -01130, -01131, & -01132
`
`
`
`Page 2 of 3
`
`Tier 4 - The prescription drug tier which consists of the higher-cost prescription drugs, most are brand-name
`prescription drugs, and some specialty drugs.
`
`Tier 5 - The prescription drug tier which consists of some of the highest-cost prescription drugs, most are
`specialty drugs.
`
`Tier 6 - The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty
`drugs.
`
`Help
`Glossary
`FAQ
`Contact
`Browser Information
`
`Protecting Your Information
`Privacy and Usage
`Fraud and Abuse
`
`Learn More
`About BCBSNC
`Community Relations
`Media Center
`Careers
`Español
`
`Health Care Partners
`Agents
`Employers
`Providers
`
`Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race,
`color, national origin, sex, age or disability in its health programs and activities. Learn more
`about our non-discrimination policy and no-cost services available to you.
`
`Information in Other Languages
`
`Español 中文 Tiếng Việt 한국어 Français
`
`اﻟﻌَرَﺑِﯾﱠﺔ
`
`Hmoob ру́сский Tagalog ગુજરાતી
`
`(cid:671)(cid:719)ែខ្មរ Deutsch िह(cid:573)ी ລາວ ⽇本語
`
`http://www.bcbsnc.com/content/services/formulary/rxdef.htm
`
`
`
`Page 3 of 3
`
`© 2017 , Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield
`Association.
`
`®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield
`Plans.
`
`http://www.bcbsnc.com/content/services/formulary/rxdef.htm
`
`
Accessing this document will incur an additional charge of $.
After purchase, you can access this document again without charge.
Accept $ Charge
Still Working On It
This document is taking longer than usual to download. This can happen if we need to contact the court directly to obtain the document and their servers are running slowly.
Give it another minute or two to complete, and then try the refresh button.
A few More Minutes ... Still Working
It can take up to 5 minutes for us to download a document if the court servers are running slowly.
Thank you for your continued patience.
This document could not be displayed.
We could not find this document within its docket. Please go back to the docket page and check the link. If that does not work, go back to the docket and refresh it to pull the newest information.
Your account does not support viewing this document.
You need a Paid Account to view this document. Click here to change your account type.
Your account does not support viewing this document.
Set your membership
status to view this document.
With a Docket Alarm membership, you'll
get a whole lot more, including:
- Up-to-date information for this case.
- Email alerts whenever there is an update.
- Full text search for other cases.
- Get email alerts whenever a new case matches your search.
One Moment Please
The filing “” is large (MB) and is being downloaded.
Please refresh this page in a few minutes to see if the filing has been downloaded. The filing will also be emailed to you when the download completes.
Your document is on its way!
If you do not receive the document in five minutes, contact support at support@docketalarm.com.
Sealed Document
We are unable to display this document, it may be under a court ordered seal.
If you have proper credentials to access the file, you may proceed directly to the court's system using your government issued username and password.
Access Government Site
