Glossary of Key Terms

Prior Authorization (PA)

Obtaining approval for a particular service or medication before it is provided.

Drug List

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).

PerformRx

Pharmaceutical network for Passport Health Plan

AB-Rated Generic

A pharmaceutical product rated in the Federal Food and Drug administration Orange Book as being equivalent to the innovator brand product.

Generic Substitution

Dispensing a generic drug in place of a brand-name medication.

Generic Drug

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.

Therapeutic Interchange

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.

Step-Therapy Protocol

A step-by-step set of directions that identifies the progression of drug therapy from first line therapy to the most aggressive drug therapy.