New 6-tier formulary redesign gives clients flexibility and value
Beginning with 2027 renewals, Premera is introducing a redesigned 6-tier formulary for commercial group plans. We’re making this change to better align drug cost, clinical value, and member cost share.
Pharmacy costs continue to rise as high-cost drugs, specialty medications, biologics, and biosimilars reshape the market. At the same time, employers want stronger cost-management tools without creating unnecessary disruption for members or adding confusion at the pharmacy counter.
This formulary redesign is about more than adding tiers. It creates clearer distinctions across drug categories, supports smarter use of lower-cost options, and helps reduce disruption by aligning cost share more consistently across similar therapies. That means a more predictable experience for clients and members while preserving access to effective medications.
- Small groups will move from a 4-tier to a 6-tier structure
- Large groups will have the 6-tier formulary as an option alongside the 4-tier
- Applies to Preferred Choice, flexible, and Premera Blue Cross HMO plans
What these tier changes look like
- splits generics into value and preferred
- splits brands into preferred and non-preferred
- splits specialty drugs into preferred and non-preferred
For producers, it adds another meaningful lever in renewal conversations. It also reflects Premera’s ongoing investment in products that help clients manage trend responsibly, minimize avoidable disruption, and deliver long-term value.
Contact your Premera account manager for more information.