Question 1

Copay assistance programs

Accepted Answer

Financial aid programs that help patients pay for their prescription medication costs, often provided by drug manufacturers or charities. They reduce out-of-pocket  expenses for eligible patients.

Question 2

Copay accumulators

Accepted Answer

Insurance policies that prevent copay assistance from counting toward a patient's deductible or out-of-pocket maximum. This means patients may still have to pay full costs once assistance runs out.

Question 3

Medical cost transparency

Accepted Answer

The practice of making healthcare prices and costs clear and accessible to patients before they receive treatment. This helps people make informed financial decisions about their care.

Question 4

Mental health parity

Accepted Answer

Laws requiring health insurance to cover mental health care just as they do physical health care. This ensures fair treatment for conditions like depression or anxiety.

Question 5

Non-medical switching

Accepted Answer

When insurance companies change coverage rules, forcing patients to switch medications for financial reasons rather than medical necessity. This can disrupt treatment and cause side effects.

Question 6

Payor

Accepted Answer

The organization or entity, such as an insurance company or government program, that pays for healthcare services. They determine what treatments and medications are covered.

Question 7

Pharmacy Benefit Manager (PBM)

Accepted Answer

A middleman company that manages prescription drug benefits for insurance plans. PBMs negotiate drug prices and decide which medications are covered.

Question 8

Prior authorization

Accepted Answer

A requirement from insurance companies that a doctor must get approval before prescribing certain medications or treatments. Without approval, the insurance may not cover the cost.

Question 9

Provider

Accepted Answer

Any healthcare professional or facility that delivers medical care, such as doctors, nurses, hospitals, and clinics. They diagnose, treat, and manage patients' health.

Question 10

Site neutrality

Accepted Answer

A policy that aims to make medical services cost the same regardless of where they are provided, such as a hospital or a doctor’s office. This prevents higher charges just because of the location.

Question 11

Step therapy

Accepted Answer

A process where insurance requires patients to try and fail on cheaper medications before covering a more expensive or brand-name drug. It can delay access to the most effective treatment.

Question 12

Vertical Integration

Accepted Answer

When a healthcare company expands by owning different parts of the healthcare system, such as hospitals, insurance plans, and pharmacies. This can increase efficiency but may also reduce competition.

Glossary of Terms