Glossary of Key Terms
Prior Authorization (PA)
Obtaining approval for a particular service or medication before it is provided.
A comprehensive list of clinically efficacious and cost-effective drug products, identified and selected by a group of knowledgeable and duly licensed clinicians, to be utilized by the Plan in order to deliver a high quality of care to members while containing costs.
Pharmacy Benefits Manager (PBM)
An entity contracted with PHP to provide pharmacy services (including performing prior authorization evaluations).
A pharmaceutical product rated in the Federal Food and Drug administration Orange Book as being equivalent to the innovator brand product.
Dispensing a generic drug in place of a brand-name medication.
Chemically equivalent copy designed from a brand-name drug whose patent has expired.
Non-Equivalent Drug Product Formulary
A list of drug(s) for which generic substitution is not required.
The dispensing of a drug product different from that which is prescribed, but which is deemed to be therapeutically equivalent to the original product prescribed.
A step-by-step set of directions that identifies the progression of drug therapy from first line therapy to the most aggressive drug therapy.