Member Resources

Glossary

Brand-name drug — a prescription medicine that is protected by a patent and generally only available from one company, which makes it more expensive. There are also repackaged generic medicines that are branded with a company's name, but these medicines are generally not covered by Community CCRx^SM, either.

Co-pay — a set cost you pay for prescriptions after you have paid the deductible.

Coinsurance — a percentage of cost that you pay for prescriptions after you have paid the deductible.

Coverage gap — also called the “donut hole,” a period in which you become responsible for paying the full costs of your medicines.

Covered drugs — a way to refer to the prescription medicines covered by our plan.

Creditable coverage — prescription drug coverage that is expected to pay out, on average, at least as much as standard Medicare drug coverage.

Customer service — a department responsible for answering your questions about membership, benefits, complaints/ grievances and appeals.

Deductible — the amount you pay for your prescriptions before your plan starts to share the costs.

Donut hole — see "coverage gap" above.

Formulary — the list of drugs covered by a plan.

Generic drug — a prescription medicine that has the same active ingredients as a brand-name medicine but costs up to 80 percent less because it is made by multiple manufacturers.

Late enrollment penalty — percentage of premium you pay above and beyond your monthly premium if you don’t have creditable prescription drug coverage and enroll in a Prescription Drug Plan after you join Medicare.

Network pharmacy — a pharmacy where members of our plan can receive their prescription drug benefits.

Out-of-network pharmacy — a pharmacy where we have NOT arranged to provide covered medicines to members of our plan.

Premium — the monthly cost you pay for a Prescription Drug Plan.

Prior authorization — approval in advance to get coverage for certain medicines that may or may not be on our formulary.

Service area — the area where we have been approved by the Centers for Medicare and Medicaid Services (CMS) to provide a Medicare Prescription Drug Plan.

Step Therapy — a medicine that will be approved only after one or more “preferred” or generic medicines have been tried and shown to be ineffective or inappropriate for safety reasons.