OUT-OF-POCKET COSTS

are expenses that are not reimbursed by your insurance and are paid for on your own.

FORMULARY

is the list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Sometimes an insurance company may request that a formulary exception request be submitted. ELIQUIS 360 Support live specialists can assist with this process.

PRIOR AUTHORIZATION

is when your doctor is required to obtain approval from your insurance plan before it will cover the costs of a specific medicine.

BENEFITS REVIEW

is a review of your pharmacy benefits to help identify your prescription coverage and potential out-of-pocket costs.

MEDICARE COVERAGE GAP OR “DONUT HOLE”

is the coverage gap that begins after you and your prescription drug plan have spent a certain amount for covered drugs in a given year. Once you reach the coverage gap, you pay no more than 25% of the price for a brand-name drug—and the remaining 75% is covered by the drug manufacturer and Medicare drug plan. To get you out of the coverage gap, what you pay and what the drug manufacturer pays will count toward your out-of-pocket spending.

DEDUCTIBLE

refers to the set amount you pay for prescriptions before your insurance plan starts to pay.