How Drug Tiers work for Community Rated Medical Plans
Standardized mapping of Ideon’s drug categories into Plansight’s Tiers 1–6. This structure ensures reliable side-by-side carrier comparisons and maintains data consistency across different benefit designs.
How drug tiers work when we pull from Ideon
Ideon organizes prescription drugs into six named categories, which we map directly into Tier 1–6 in Plansight:
- Generic
- Non-Preferred Generic
- Brand
- Non-Preferred Brand
- Specialty
- Non-Preferred Specialty
This mapping doesn’t mean every carrier actually uses all six tiers. Some carriers may only have three or four tiers in their benefit design.
What you’ll see in Plansight
- Overlap between tiers: Sometimes a carrier covers Tier 1 and Tier 2 the exact same way (for example, both at “$10 copay”). That’s not a mistake — it just reflects how their plan is designed.
- Not applicable tiers: If a carrier doesn’t have a certain tier (like Non-Preferred Specialty), that cell will show up as Not Applicable (N/A) or remain empty.
- Consistent mapping: We don’t try to “flatten” or guess. We pull Ideon’s structure straight into the same Tier 1–6 slots every time.
Why this matters
- You always know where to look for a drug category. Specialty drugs, for example, will always be in Tier 5, so you can compare them across carriers even if one has 3 tiers and another has 6.
- The consistency makes side-by-side comparisons more reliable and easier to explain to brokers and clients.
- It removes ambiguity — you can see exactly how each carrier structured their benefits without us reshaping the data.
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