Glossary
Biosimilar medication
Biosimilars are alternatives to FDA-approved biologics that are used to treat serious and complex conditions. They have no clinically meaningful differences in safety and effectiveness compared to the original biologic but cost significantly less.
Formulary
This is your plan’s list of covered prescription medications, based on factors including clinical effectiveness, safety, and cost. This list is updated quarterly and promotes the use of generic or preferred brand-name medications when possible.
Generic medication
Generic medications contain the same or similar active ingredients as their brand-name counterparts but typically cost less. The U.S. Food and Drug Administration (FDA) requires generics to be as safe and effective as their brand-name counterparts.
Generic Step Therapy Program
The Generic Step Therapy Program encourages EUTF active employees and non-Medicare retirees to try generic medications before brand-name alternatives for certain conditions. You may need to try a generic treatment first before your plan covers the brand version of the same medication.
Maintenance medication
Maintenance or long-term medications are usually filled in a 90-day supply and are taken for an extended period. They’re used to treat chronic conditions like high blood pressure, diabetes, or high cholesterol. For EUTF members, new maintenance medications are limited to one initial fill plus two refills before requiring a 90-day supply. You’ll pay the lowest copay for a 90-day supply at participating Retail 90 or CVS Caremark Mail Pharmacy locations.
Prior Authorization
A pre-approval process required for certain medications to ensure they are medically necessary before your plan provides coverage. Your doctor must request approval before you can fill the prescription. Your doctor can call 1-808-254-4414 to request approval or submit a medical exception request.
Quantity Limitations
Quantity Limitations are restrictions on the amount of medication you can receive at one time, based on FDA guidelines and medical studies to ensure safe usage.
Retail 90
A network of participating pharmacies where EUTF members can get 90-day supplies at a discounted rate. You’ll pay two times your 30-day copay for a 90-day supply, which offers savings compared to monthly refills.
Short-term medication
Short-term medications, also called immediate or acute medications, are filled in up to 30-day supplies. They’re used for conditions that need immediate treatment like coughs, colds, flu, and infections. You can fill these prescriptions at any pharmacy in your plan’s retail network.
Specialty Guideline Management (SGM)
SGM uses evidence-based care plans and medication management programs to help you properly use complex specialty medications. All specialty medications require prior authorization through this program.
Specialty medication
Specialty medications treat complex chronic conditions or genetic disorders like cancer, multiple sclerosis, growth hormone disorders, and immune deficiencies. They can be injectable, IV infused, oral, or inhaled. Specialty medications typically require special storage and handling and cost more than standard medications.