As you start treatment with FABHALTA, you may come across new or confusing terms. This list can help you with insurance terms you might encounter along the way.
INSURANCE GLOSSARY
Appeal
A request for your insurance company to reconsider its decision about denying coverage of your medication.
Benefits verification
This is when the insurance company reviews your coverage. This may identify a need for a prior authorization or what out-of-pocket costs may be for this prescription.
Co-pay
A predetermined, fixed amount you pay for your medication after your health plan covers a portion of the total cost.
Co-insurance
The percentage of covered medical costs you’ll pay after you’ve reached your deductible.
Deductible
The amount you pay for a prescription before your insurance starts to pay its portion of the cost.
Formulary
A list of prescription medications covered by a prescription medication plan or another insurance plan offering prescription medication benefits.
Government insurance
Insurance reserved for specific groups of people (eg, senior citizens, persons with low income, persons with disability, current military and their families, government employees, and some federally recognized Native American tribes) and funded by the government. Medicare, Medicaid, TRICARE, and the Veterans Health Administration program are all examples of government insurance.
Out-of-pocket maximum
The most you have to pay for prescription medications in a year. After you spend this amount on deductibles, co-pays, and co-insurance, your insurance plan covers 100% of the cost.
Patient support program
A program like Novartis Patient Support that helps patients, caregivers, and health care professionals find the right support when they need it.
Premium
The amount you pay for your health insurance every month.
Prior authorization
An approval given by your insurance so your prescription is covered by your plan.
Private insurance (sometimes called commercial insurance)
Insurance you buy individually or through your employer.
Retail pharmacy
An independent or chain pharmacy that dispenses medications to the general public at retail prices.
Specialty pharmacy
A pharmacy that carries medications that require specific handling and storage.
Step therapy
A process by which insurers (public or private) require patients to take one or more alternative medications before they can access the medicine prescribed by their provider.
