What is the primary cost-sharing structure of Tier 5 in prescription plans?

The primary cost-sharing structure of Tier 5 in prescription plans involves the member paying coinsurance for medications, particularly for unique and/or very high-cost drugs. This tier is designed to accommodate specialty medications, which are often high in cost and may require additional management or oversight due to their complexity.

Coinsurance means that members pay a percentage of the drug's cost rather than a fixed copayment amount. This approach allows for a fairer sharing of costs between the insurance company and the member, especially considering the high prices often associated with specialty medications. By having this structure, insurance plans ensure that they can continue to cover expensive treatments while also placing some financial responsibility on members to encourage the appropriate use of these costly drugs.

The other options highlight different cost structures that do not apply to Tier 5. For example, paying copayments exclusively (which suggests a fixed cost) does not align with the nature of high-cost medications. Similarly, Tier 5 does not typically include all medications at no cost or require members to pay full price for all medications, as these would not support the intended financial model for managing specialty drugs.