FOLevel 1

Formulary Tier Types

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FO.01Tier 1 - Preferred Generic

FO.02Tier 2 - Generic

FO.03Tier 3 - Preferred Brand

FO.04Tier 4 - Non-Preferred Brand

FO.05Tier 5 - Specialty

FO.06Tier 6 - Specialty (High Cost)

FO.07Prior Authorization Required

FO.08Step Therapy Required

FO.09Quantity Limit

FO.10Over-the-Counter (OTC)

FO.11Preventive Drug List

FO.12Specialty Mail Order

FO.13Limited Distribution

FO.14Formulary Exception

No cross-system equivalences mapped for this node.