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Step therapy protocol

A practice where health insurance plans require patients to try a less expensive medication (typically a generic) first before they will cover a more expensive, often brand-name, drug for the same condition.

Group health plan

A health plan that provides healthcare coverage to employees and their families through an employer or employee organization.

Participant or beneficiary

An individual who is covered by a health insurance plan (participant) or who receives benefits under the plan (beneficiary), often a spouse or dependent of the participant.

Prescriber

A healthcare professional, such as a doctor, who is authorized to prescribe medications.

Contraindicated

A situation or condition that makes a particular treatment or procedure inadvisable due to the potential for harm.

Employee Retirement Income Security Act of 1974 (ERISA)

A federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.