SKYRIZI (risankizumab) is typically listed on Tier 5 of prescription drug formularies, especially within Medicare prescription drug plans.
Understanding Drug Tiers and SKYRIZI's Placement
Drug tiers are a common way insurance companies categorize medications, directly influencing the out-of-pocket cost for patients. Generally, the higher the tier, the greater your financial responsibility for the medication. SKYRIZI's placement on Tier 5 indicates it is often classified as a specialty drug.
Specialty drugs are typically high-cost medications used to treat complex or chronic conditions, often requiring special administration or handling.
Here's a general breakdown of how drug tiers typically work:
- Tier 1: Preferred Generics
- These are usually the lowest-cost options, often with the smallest co-pay.
- Tier 2: Preferred Brand-Name Drugs
- These medications are brand-name but often have a lower co-pay than non-preferred brands.
- Tier 3: Non-Preferred Brand-Name Drugs
- These drugs generally have a higher co-pay than preferred brand-name medications.
- Tier 4 (or Non-Preferred Specialty Tier):
- This tier may include higher-cost specialty drugs that are not on the highest tier but still require significant out-of-pocket expenses.
- Tier 5: Specialty Drugs
- This is typically the highest tier, reserved for very high-cost, complex medications like SKYRIZI. Patients often pay a high co-payment or a percentage of the drug's cost (coinsurance).
Simplified Overview of Drug Tiers
| Drug Tier | Description | Typical Cost Impact |
|---|---|---|
| Tier 1 | Preferred Generics | Lowest out-of-pocket cost |
| Tier 2 | Preferred Brand-Name Medications | Low to moderate cost |
| Tier 3 | Non-Preferred Brand-Name Medications | Moderate to high cost |
| Tier 4 | Non-Preferred Specialty (or similar) | High cost |
| Tier 5 | Specialty Drugs (like SKYRIZI) | Highest out-of-pocket cost |
Factors Influencing Your SKYRIZI Cost
While SKYRIZI is commonly on Tier 5, your specific out-of-pocket cost can vary based on several factors unique to your insurance plan:
- Specific Plan Formulary: Each prescription drug plan, including those under Medicare Part D, has its own formulary and tier structure.
- Deductibles: You may need to meet your plan's annual deductible before your coverage for Tier 5 medications fully begins.
- Coinsurance vs. Co-pay: Many Tier 5 drugs involve coinsurance (a percentage of the drug's cost) rather than a fixed co-pay, meaning your cost fluctuates based on the drug's price.
- Patient Assistance Programs: Due to the high cost of specialty drugs, many pharmaceutical manufacturers and non-profit organizations offer patient assistance programs that can help reduce out-of-pocket expenses.
For the most accurate information regarding SKYRIZI coverage and your specific costs, it is always best to consult your individual prescription drug plan's formulary or contact your plan provider directly.
