Formulary tier
The vocabulary of getting a claim paid, of FDA enforcement, and of what on-label and off-label really mean.
What is Formulary tier?
Where a drug sits in a plan's cost-sharing ladder: Tier 1 generic, Tier 2 preferred brand, Tier 3 non-preferred brand, Tier 4 specialty.
Wegovy and Zepbound usually land in Tier 3 or 4 on commercial plans, so copays of $100–$500 a month are normal even after approval, and some plans exclude them outright. No generic exists, because semaglutide's US patent runs to 2032.
GLP Watchdog writes these definitions from FDA labels and peer-reviewed PubMed literature.
Where Formulary tier comes up on this site
Drug pages
Connected terms
Other terms under Insurance and regulatory
Where the evidence lives
- The full GLP-1 glossary (150 terms, 8 categories)
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