Formulary tier
Coverage barriers, FDA enforcement, and the off-label vs on-label distinction.
Definition
The cost-share level a prescription drug occupies in an insurance plan's formulary (covered drug list). Tier 1 = generic ($), Tier 2 = preferred brand ($$), Tier 3 = non-preferred brand ($$$), Tier 4 = specialty (highest copay). Wegovy and Zepbound are typically Tier 3 or 4 on commercial plans — meaning copays of $100-$500+/month even after approval. Some plans exclude them entirely. Generic GLP-1s do not yet exist (semaglutide patent runs through 2032 in the US).
Definition curated by Weight Loss Rankings — sourced from FDA labels and peer-reviewed PubMed literature, never AI-generated summaries.
Related terms in Insurance and regulatory
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