GS-POPS Three-Tier Prescription Copay Programs



The management team at GS-POPS remains dedicated to our goal of providing innovative employee prescription benefit programs which provide the highest quality, cost-effective pharmaceutical care.

The most effective way to control prescription drug costs is through the use of generic medications. We encourage all of our members to ask their physicians to authorize a generic substitute whenever possible.

When a generic substitute is not available, there may be more than one brand name medication that may be clinically appropriate for a specific treatment. For this reason, many employee prescription benefit programs administered by GS-POPS have adopted Three-Tier Prescription Copay Programs in conjunction with a Preferred Product Formulary.

The following are some frequently asked questions regarding these programs. Should you have additional questions, please feel free to contact us at 1-800-778-8089.


What are Copay Tiers, and how do they affect what I actually pay at the pharmacy?
Within a Three-Tier Prescription Copay Program, prescription drug products are categorized within three tiers: Tier 1, Tier 2, and Tier 3.

Each Tier is assigned a specific copay, which is the amount you pay when you visit the pharmacy to fill your prescriptions, or order your medications through home delivery (if applicable). The following guidelines apply:

Tier 1 is the lowest copay option.
If your prescription is for a generic medication, you will pay the lowest copay (Tier 1). For the lowest out-of-pocket expense, you should always consider Tier 1 drugs if you and your physician decide they are appropriate for your treatment.
Tier 2 is the middle copay option. If there is no generic medication available that is clinically appropriate for your treatment and your physician prescribes a brand name medication which is on a Preferred Product Formulary, you will pay the middle copay. (Tier 2). For the lowest out-of-pocket expense, if a generic medication is not available to meet your needs, you should always ask your physician to prescribe a brand name medication on a Preferred Product Formulary whenever possible.
Tier 3 is your highest copay option. If there is a generic medication available that is clinically appropriate for your treatment and you or your physician choose a brand name medication which is NOT on a Preferred Product Formulary, you will pay the highest copay. (Tier 3).


What is the difference between brand name and generic medications?
Generic drugs medications contain the same active ingredients as their brand name counterparts, but they often cost less. Generic drugs can become available only after the patent and market exclusivities on the brand name drug expires. At that time, other companies are permitted to manufacture a chemically equivalent drug. Before a generic drug can be sold, the FDA must be satisfied that the drug contains the same active ingredients in the same strength as the brand name equivalent. It must also meet the same standards of quality and effectiveness.


How are brand name medications selected for a Preferred Product Formulary?
The goal of a Preferred Product Formulary is to provide members of a Three-Tier Employee Prescription Copay Program with access to quality medications, while promoting appropriate and cost-effective therapy. The FDA-approved brand name and generic medications chosen for a Preferred Product Formulary are selected based on their safety, effectiveness and overall value.


Does a Preferred Product Formulary ever change?
A Preferred Product Formulary is subject to our periodic review and modification. Medications may be added to or removed from a Preferred Product Formulary at any time for the following reasons:

Many brand-name medications lose their patents and generic versions become available. In this case, the brand-name medication may be covered at a higher copay.
The FDA approves many new medications throughout the year. These brand name medications may be added to a Preferred Product Formulary and may replace other medications currently on a Formulary, based on cost-effectiveness.
Medications may be withdrawn from the market or become available without a prescription. These medications may be removed from a Preferred Product Formulary as necessary.




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