`
`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
`
`
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`Page 2 of 3
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`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.
`
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