TMRW

Pharmacy

Prior authorization

A requirement that a provider get approval from the insurer before prescribing certain medications, treatments, or procedures. Used to control costs on high-priced or specialty drugs. Adds time and friction; can be reversed on appeal.

Last reviewed: · TMRW Benefits is a benefits brokerage, not a tax or legal advisor. Consult a CPA or attorney for situation-specific guidance.

Related terms

Formulary

List of drugs covered by a plan, in tiers.

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Step therapy

Try lower-cost drugs before insurer covers expensive alternatives.

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Specialty drug

High-cost drug for complex conditions. Higher tier.

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More in Pharmacy

Formulary

List of drugs covered by a plan, in tiers.

Step therapy

Try lower-cost drugs before insurer covers expensive alternatives.

Generic vs brand drugs

Generic = same chemistry, lower cost than brand.

Specialty drug

High-cost drug for complex conditions. Higher tier.

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