What is the payment structure for drugs listed under Tier 4?

The structure for drugs categorized under Tier 4 typically involves copayment or coinsurance for non-preferred drugs. This tier often includes medications that are not first-line treatments or those that are more expensive, reflecting their status as less preferred options compared to drugs in lower tiers. As such, insurance plans will require members to share in the costs of these medications through a copayment (a fixed amount paid) or coinsurance (a percentage of the total cost), depending on the specific terms of the insurance policy.

This payment strategy helps to manage costs for both the insurer and the insured by encouraging the use of preferred medications that are usually in lower tiers, which are more cost-effective, while still providing access to necessary options that may be more expensive. Understanding this tier structure is crucial for beneficiaries when navigating their prescription drug benefits.