6-tier formulary redesign offers new flexibility and value in 2027

Beginning with 2027 renewals, Premera is introducing a redesigned 6-tier formulary. 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, we know our 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 you and your employees, 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

Want to know more? Contact your Premera account manager or producer for more information.