Glossary
The words that decide
whether you can afford treatment.
Coverage decisions are made in vocabulary most people never get taught. These are the terms that come up most, defined against their cited public source.
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Biosimilar
A biological medicine highly similar to an approved reference product, with no clinically meaningful differences from it.
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Coverage appeal
A formal request asking your health plan to reconsider a denial.
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Explanation of benefits (EOB)
A statement from your plan showing what a claim covered and what you may owe. It is not a bill.
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Formulary tier
The cost-sharing band a plan assigns a medicine on its covered-drug list.
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Prior authorization
Approval your health plan must give before it will cover a specific medicine, test, or procedure.
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Step therapy
A rule requiring you to try a plan-preferred medicine first before a different one is covered.
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