TMRW

Pharmacy

Step therapy

A formulary rule requiring patients to try lower-cost medications before the insurer covers a more expensive alternative. Common with chronic conditions where multiple drug options exist. Can be appealed if clinically inappropriate.

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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Prior authorization

Insurer pre-approval for certain treatments.

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More in Pharmacy

Formulary

List of drugs covered by a plan, in tiers.

Prior authorization

Insurer pre-approval for certain treatments.

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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