Coverage Levels
Acronyms
Definitions
100
This level does not apply to all plans
What is Deductible
100
LIS
What is Low-Income Subsidy
100
A drug approved through this path is considered a brand
What is Biologic License Application (BLA)
200
This when both the plan and the member pays for coverage
What is Initial Period/Benefit Period
200
TrOOP
What is True Out Of Pocket
200
This is dependent on the way the prescription is written and is in 30, 60, or 90 days.
What is Day Supply
300
This level is also known as the Donut Hole
What is Coverage Gap
300
SPAP
What is State Pharmaceutical Assistance Program
300
These cost are calculated based on the plan year
What is Out-Of-Pocket
400
This level is reached once the member has reached it's TrOOP cost?
What is Catastrophic Coverage
400
QL
What is Quantity Limit
400
There may be effective, lower-cost drugs that treat the same medical condition as this drug.
What is Step Therapy
500
These member have only Part D coverage with UHC
What is PDP Members
500
NDA
What is New Drug Application
500
This means the plan needs more information from your doctor to make sure the drug is being used correctly for a medical condition covered by Medicare.
What is Prior Authorization (PA)
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