What are Tier 5 drugs typically categorized as?

Tier 5 drugs are categorized as specialty medications that often require higher cost-sharing from members. This classification typically indicates that these drugs are used to treat complex, chronic, or rare conditions, often requiring special handling, administration, or monitoring. Due to their specialized nature and high cost, insurance plans usually place these medications in the highest tier, reflecting the increased expense involved in their procurement and management.

Specialty medications may include biologics, infused drugs, or other therapies that necessitate additional resources for safe and effective administration. As a result, they often carry higher out-of-pocket costs for patients, including deductibles, co-pays, or co-insurance. This structure is designed to manage the overall costs of healthcare while ensuring patients have access to necessary advanced treatments.

Other options do not align with the characteristics of Tier 5 drugs. Medications classified as completely free would not fit within a tiered pricing structure, while over-the-counter medications and commonly used generic drugs are typically found in lower tiers due to their lower costs and broader accessibility.