Specialty tier definition

Specialty tier means a formulary category for a
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Specialty tier means a tier of cost sharing designed for select specialty drugs that imposes cost-sharing
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Specialty tier means a tier of cost sharing designed for select specialty drugs that imposes a cost-sharing obligation that is based on a coinsurance or copayment and exceeds that amount for non-specialty drugs.
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Examples of Specialty tier in a sentence

  • Specialty tier pricing may not be cost effective for employers in the long run due to increased medical costs that can result from decreases in treatment adherence.

  • In general, the higher the cost-sharing tier, the higher your cost for the drug:• Tier 1: Preferred generic• Tier 2: Generic• Tier 3: Preferred brand• Tier 4: Non-preferred brand• Tier 5: Specialty tier (generic and brand)• Tier 6: Supplemental brand and generic (excluded drugs only)Each drug is assigned to a specific “tier” within the formulary.

  • It was lost in the event of “non insured losses until full payment paid”.

  • It explains the procedures and deadlines that have been set by Medicare to make sure your request is handled promptly and fairly.Drugs on our Specialty tier (Tier 5) are not eligible for this type of exception.

  • We do not lower the cost‑sharing amount for drugs in the Preferred tiers, for any drug in the Specialty tier, or any drugs in Tier1.

  • Some of the drugs in this category also have a generic equivalent in Tier 1- Preferred Generics or Tier 2 - Generics that is often a better value.• Tier 5: Specialty – Specialty tier drugs are high-cost medications and biologicals, regardless of how they are administered (injectable, infusible, oral, transdermal or inhaled).

  • Drugs of our tier 5 Specialty tier are not eligible for this type of exception.

  • Note: Specialty tier (Tier 5) drugs are not eligible for a tier exception.

  • Drugs in our Tier 5 – Specialty tier are not eligible for this type of exception.

  • A Specialty tier drug is a very high cost or unique prescription drug which may require special handling and/or close monitoring.

Related to Specialty tier

  • Specialty coating means any coating that is manufactured and used for one (1) of the following specialized applications:

  • Specialty Drugs means drugs listed on the Approved Drug List meeting certain criteria, such as:

  • Specialty drug means a prescription drug that:

  • Specialty means a broad, population-based focus of study encompassing the common health-related problems of a particular group of patients and the likely co-morbidities, interventions, and responses to those problems.

  • Specialty fertilizer means a fertilizer distributed primarily for nonfarm use.

  • SPECIALTY HOSPITAL means a hospital or the specialty unit of a general hospital that is licensed by the state. It must be designed to care for patients with injuries or special illnesses. This includes, but is not limited to, a long-term acute care unit, an acute mental health or acute short-term rehabilitation unit or hospital. Hospital does not mean: • convalescent home; • rest home; • nursing home; • home for the aged; • school and college infirmary; • residential treatment facility; • long-term care facility; • urgent care center or freestanding ambulatory surgical center; • facility providing mainly custodial, educational or rehabilitative care; or • a section of a hospital used for custodial, educational or rehabilitative care, even if accredited by the JCAHO or listed in the AHA directory.

  • Specialty contractor means a person who is licensed to conduct business as described in subsection 4 of NRS 624.215.

  • Distribution center means a building or structure used primarily for the storage of goods which are intended for subsequent shipment to retail outlets. Distribution center does not mean a building or structure used primarily to store raw agricultural products, used primarily by a manufacturer to store goods to be used in the manufacturing process, used primarily for the storage of petroleum products, or used for the retail sale of goods.

  • Abbeyfield Home means an establishment run by the Abbeyfield Society including all bodies corporate or unincorporated which are affiliated to that society;

  • Non-Participating Home Infusion Therapy Provider means a Home Infusion Therapy Provider who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Hospice patient s family" means a hospice patient's immediate family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

  • Tobacco use means any use of tobacco products within the past two months. Tobacco use, however, does not include the religious or ceremonial use of tobacco.

  • Retail seller means any person that sells any dangerous drug to consumers without assuming control over and responsibility for its administration. Mere advice or instructions regarding administration do not constitute control or establish responsibility.

  • Outpatient hospital services means preventive, diagnostic, therapeutic, observation, rehabilitation, or palliative services provided to an outpatient by or under the direction of a physician, dentist, or other practitioner by an institution that:

  • Hospital/Nursing Home : means any institution established for in- patient care and day care treatment of sickness and / or injuries and which has been registered as a Hospital with the local authorities, wherever applicable, and is under the supervision of a registered and qualified Medical Practitioner OR must comply with all minimum criteria as under:

  • Nursing home-type patients means a patient who has been in hospital more than 35 days, no longer requires acute hospital care, cannot live independently at home or be looked after at home, and either cannot be placed in a nursing home or a nursing home place is not available.

  • Retail tobacco store means a retail store utilized primarily for the sale of tobacco products and accessories and in which the sale of other products is merely incidental.

  • Homebound or "hospitalized" means a pupil who is capable of

  • Dental Services means diagnostic, preventive, or corrective

  • Participating Home Infusion Therapy Provider means a Home Infusion Therapy Provider who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Distribution Company means a distribution company as defined in Section 1 of Chapter 164 of the Massachusetts General Laws.3

  • Retail choice means the ability of retail customers to shop for

  • Nonambulatory means a person who immediately and without the aid of another is not physically and mentally capable of traveling a normal path to safety, including the ascent and descent of stairs.

  • Health-care-insurance receivable means an interest in or claim under a policy of insurance which is a right to payment of a monetary obligation for health-care goods or services provided.

  • Life insurance producer means any person licensed in this state as a resident or nonresident insurance producer who has received qualification or authority for life insurance coverage or a life line of coverage pursuant to chapter 522B.

  • veterinary surgeon means a veterinary surgeon within the meaning of the Veterinary Surgeons Act 1936.