Formulary Status
Health plans create formularies to manage drug costs. Each drug is reviewed and place on a tier. Typically, generic drugs are on Tier 1 and branded products are place on Tier 2 or 3. The co- pay or co-insurance will vary depending on which Tier the drug is placed. If a branded product is preferred it will be covered at a lower copay than a non-preferred drugs. Products that are non-covered may require submitting an exception request for health plan approval.

Step Therapy (ST)
When a health plan requires use of a certain medication/treatment before using another medication.

Prior Authorization (PA)
When a health plan needs to verify that the medication prescribed is medically necessary; once approved the prescription will be covered by the health plan.