Dictionary
The Dictionary provides concise definitions of health economics terms, arranged alphabetically for quick reference. Use it to understand unfamiliar terminology or confirm the meaning of a specific term.
B
- Brand TierBrand Drug Tier, Branded Formulary Tier
- A formulary category for brand-name drugs within a tiered insurance design, typically carrying higher cost-sharing than generic drugs in a lower tier.
D
- Drug Evaluation CommitteeDEC, Formulary Committee
- A formally constituted expert body responsible for reviewing evidence for a pharmaceutical product and recommending its reimbursement or formulary inclusion.
E
- Exclusion ListNon-Covered Drug List, Drug Exclusion Roster
- A list of medications explicitly not covered under a health plan's formulary, typically due to available clinically equivalent, lower-cost alternatives.
F
- FormularyPreferred Drug List, Approved Medication List
- A list of medications approved for coverage by a health plan or system, often organised into tiers reflecting patient cost-sharing levels.
- Formulary DesignFormulary Structuring, Tier Design
- The process of determining a health plan's covered medication list structure, covering tier placement, prior authorisation, and access balance.
- Formulary ManagementFormulary Administration, Drug List Management
- The ongoing process by which a plan develops, maintains, and updates its covered medication list, covering tier placement and prior authorisation.
- Formulary SubmissionFormulary Dossier, Formulary Application
- A formal manufacturer application presenting clinical and economic evidence supporting a medication's inclusion on a plan's formulary.
G
- General ListingOpen Formulary Listing, Standard Listing
- The inclusion of a treatment within a health system's standard, unrestricted formulary, without special authorisation or subgroup limitation.
- Generic TierTier 1 Generic, Lowest Cost-Share Tier
- A formulary category for generic drugs within a tiered insurance design, typically carrying the lowest cost-sharing to encourage their use.
L
- Listing DecisionPositive Listing, Reimbursement Listing
- A formal determination on whether a treatment will be included on a health system's approved formulary, and under what conditions.
N
- Negative ListDelisted Formulary, Non-Reimbursed List
- A list of medications or services explicitly excluded from reimbursement coverage, unlike a positive list specifying what is covered.
- Non-Medical SwitchingPayer-Driven Switching, Cost-Driven Switching
- A situation where a patient's medication is changed for reasons unrelated to clinical response, such as an insurer's formulary change.
- Non-Preferred DrugNon-Formulary Drug, Excluded Drug
- A medication assigned to a higher-cost formulary tier, typically with greater patient cost-sharing than a preferred alternative, to encourage lower-cost use.
- Non-Preferred TierHigh Cost-Share Tier, Non-Formulary Tier
- A formulary or network category with the highest cost-sharing in a tiered design, applied to options an insurer wishes to discourage.
P
- Preferred DrugFirst-Line Formulary Choice, Favoured Formulary Agent
- A medication assigned to a lower-cost formulary tier, typically with lower patient cost-sharing, to encourage its use over costlier alternatives.
- Preferred TierLow-Copay Tier, Favoured Cost Tier
- A formulary or network category with more favourable, typically lower, cost-sharing in a tiered design, encouraging use of preferred options.
R
- Rebate AgreementDiscount Agreement, Refund Contract
- A formal contract establishing the terms under which a rebate will be paid, including the percentage and any formulary or utilisation conditions.
S
- SMCScottish Medicines Consortium, Scotland HTA
- The Scottish Medicines Consortium, advising Scotland's NHS boards on the clinical and cost-effectiveness of newly licensed medicines for local formulary decisions.
- Specialty TierSpecialty Formulary Tier, Biologics Tier
- A formulary category for high-cost specialty medications, typically biologics, usually carrying the highest patient cost-sharing of any tier.
- Specialty Tier PlacementTier Assignment, Specialty Tier Decision
- The decision to assign a medication to a formulary's specialty tier, typically based on cost or complex handling, raising patient cost-sharing.
- SwitchingTherapy Change, Product Change
- A general term for a change from one medication to another, whether for clinical reasons or non-clinical reasons such as a formulary change.
U
- Unrestricted ListingOpen Listing, Unrestricted Reimbursement
- The inclusion of a treatment on a formulary without limitations on patient eligibility or prior authorisation, following a positive value finding.