<\/p>\n
If you’re facing the opportunity to choose a new drug coverage plan for you and your family, you need to speak the language in order to weigh the costs and benefits.<\/p>\n
<\/p>\n
Brand name (drug):\u00a0<\/strong>A one-of-a-kind drug that is still protected by a patent.<\/p>\n Co-pay<\/strong>\u00a0(or co-payment):\u00a0<\/strong>A fixed amount, for example $10, that an insured individual pays for health services, regardless of the actual cost of that service.<\/p>\n Co-insurance:<\/strong>\u00a0A percentage of the cost of a health service, usually 20%, paid by the insured individual.<\/p>\n Deductible:\u00a0<\/strong>An amount an insured individual must pay for health services before their insurance plan begins to pay any benefits. For example, the individual may be required to pay the first $500 before the insurance company will pay for subsequent services.<\/p>\n Formulary:<\/strong>A list established by a health plan or PBM to indicate which drugs they cover or which tier drugs are in.<\/p>\n Generic drug:<\/strong>\u00a0A drug that is no longer patent protected, so that many companies can copy and manufacture the drug with the same active ingredient as the original inventor.<\/p>\n Mail Order<\/strong>:<\/strong>\u00a0Prescriptions that are received in the mail.<\/p>\n Out-of-Pocket Maximum<\/strong>:\u00a0<\/strong>An upper limit on how much an individual or family must pay in a year for health services.\u00a0Once the limit is reached, co-insurance and sometimes co-payments do not have to be paid.<\/p>\n OTC Drugs:\u00a0<\/strong>Over-the-counter (OTC) drugs can be purchased without a prescription and are generally not covered by insurance.<\/p>\n Pharmacy Benefit Manager<\/strong>\u00a0(PBM):\u00a0<\/strong>A company that administers a pharmacy benefit plan. They aren\u2019t insurance companies; but are often subcontracted by health insurers or employers to manage the prescription drug portion of the health plan.<\/p>\n Prior authorization:<\/strong>A requirement that a physician obtains approval from the health plan or PBM in order to get the medicine covered.<\/p>\n Step therapy:\u00a0<\/strong>A requirement of the health plan or PBM to try a less expensive drug first. If that drug fails to work on the patient, the health plan or PBM will then approve the use of a more expensive drug.<\/p>\n Therapeutic substitution:<\/strong>\u00a0The process of switching an existing prescription to one that is less expensive and chemically different, but has the same expected clinical effect.<\/p>\n Tiered co-pay (co-payments)<\/strong>:\u00a0<\/strong>A co-payment that is determined by which tier the drug is assigned to by the health plan or PBM.\u00a0There may be a few tiers, each with a different co-payment amount. This design is intended to encourage the use of drugs that are in the less expensive tiers.<\/p>\n","protected":false},"excerpt":{"rendered":" If you’re facing the opportunity to choose a new drug coverage plan for you and your family, you need to speak the language in order to weigh the costs and […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false},"categories":[25],"tags":[],"acf":[],"_links":{"self":[{"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/posts\/1921"}],"collection":[{"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/comments?post=1921"}],"version-history":[{"count":3,"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/posts\/1921\/revisions"}],"predecessor-version":[{"id":11736,"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/posts\/1921\/revisions\/11736"}],"wp:attachment":[{"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/media?parent=1921"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/categories?post=1921"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nclnet.org\/wp-json\/wp\/v2\/tags?post=1921"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}