Definitions of terms
- Contraindications*: a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the patient.
- Co-pay: at the time a claim is submitted for reimbursement of a treatment, the patient may have to pay a portion of the total cost.
- For a stepped approach, you need to have tried, without a successful outcome, generally cheaper treatments before they will cover the one or ones on a higher step.
- For tiered programs, there are tiers within a given step, based entirely on the cost of each medication to the insurer, and if you try to access a medication on a higher tier without having tried a lower tier one, you will likely be asked for a higher co-pay , or have the coverage denied.
- Human resources manager: the staff member or department in charge of employee benefits such as health benefits within the organisation where the patient is employed.
- Insurance companies: health coverage provided and paid (partly or fully) by a person’s employer or by a separate company that offers health insurance plans paid by the patient.
- NIHB = non-insured health benefits
- No coverage: patient does not have any private coverage and perhaps, does not qualify for public coverage.
- Off-label: instances when a drug approved for one condition is prescribed by a physician for a different condition (that has shown effectiveness for that condition).
- Pharmaceutical financial support services for patients: many pharmaceuticals offer financial support to patient to help them pay for the cost of the medication they manufacture. Patients usually have to work with their physician to acquire this funding.
- Prerequisite: if your insurance provider requires you to try another medication before they will approve your first choice, you should research the "qualifications" of this medication. You may be able to 'skip' the prerequisite medication and move forward with your first choice medication if your doctor can send a note to the insurance company explaining why you can't try the prerequisite drug first. See the contraindication chart.
- Private health insurance: health coverage provided and paid (partly or fully) by a person’s employer or by a separate company that offers health insurance plans paid by the patient.
- Public health coverage: health coverage provided by a government body, in Canada, usually a provincial department.
- Seeing a specialist: when conditions become chronic and/or previous treatments have not shown any improvements, patients can ask their family physician to see a specialist. In the case of psoriasis this would be a dermatologist. For psoriasis related joint pain or psoriatic arthritis, a rheumatologist is recommended.
- Special access or restricted access orspecial authorization to a medication: in some provinces, a special request can be made to ask for an exception in regards to the conditions for which a drug in covered. Usually it requires you to have tried (and 'failed') other therapies first and require your doctor to send some forms in to the Ministry of Health or to the Health Authority for approval.
- Stepped /tiered approach to psoriasis treatment: virtually all plans that cover treatments have either a stepped approach to covering treatments or a tiered one, or in some cases both.
* U.S. National Library of Medicine