The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National
Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering
information for and developing this patient education guide. This guide represents a brief summary of the medication derived from
information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the
possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should
not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does
not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume
no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with
respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual
consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a
qualified healthcare professional.
Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of
concise, easy-to-understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to
patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding
or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing
inquiries to Contact@NCODA.org.
Cookies are required to agree to our terms of service. We only use this cookie to grant access to our library.
This sheet is coming soon. check back later to download it as an Adobe PDF.
SPECIALTY PHARMACY INSURANCE TERMS ORAL CHEMOTHERAPY EDUCATION Appeal An appeal is a request for your health insurance to go back and review a decision that denies a drug or service. It is often needed if your health insurance denies a prior authorization. Coinsurance This is the percent of the cost for a health service or drug that you pay after you’ve paid your deductible. For example, you may have to pay 20% coinsurance for each drug after you have paid your deductible. Copayment (“copay”) A copay is a fixed amount you pay for a covered healthcare service after you’ve paid your deductible. For example, you may have to pay a $20 copay for each prescription after you have paid your deductible. Deductible A deductible is the amount you pay for covered healthcare services before your insurance plan starts to pay for these same services. If you have a $1,000 deductible, you would need to pay $1,000 of the covered services before your insurance starts paying. Formulary A formulary is a list of preferred drugs covered by a health plan that offers drug benefits. It is also called a drug list. Grant Grants are given by nonprofit companies to help with the cost for drug coinsurance, copays, deductibles, health insurance premiums, and other selected out of pocket healthcare costs. The availability of these may vary based on the disease or medicine. Patient assistance program (PAP) These programs are created to help patients who lack health insurance or drug coverage or are unable to pay for their medicine. They often are offered by drug companies to give low cost or free medicines to patients who qualify and do not have Medicare or Medicaid. Prior authorization A prior authorization is a choice by your health insurance that a healthcare service, treatment plan, or prescription drug is medically needed. It may also be called preauthorization, prior approval, or precertification. Your health insurance may require this for certain services before you get them. It is not a promise that your health insurance will cover the cost. Bibliography Academy of Managed Care Pharmacy. (2016). The AMCP format for formulary submissions (version 4.0). Retrieved from http://www.amcp.org/ FormatV4/ American Pharmacists Association. (n.d.). Pharmacy benefit management. Retrieved from https://www.pharmacist.com/sites/default/files/files/ Profile 24 PBM SDS FINAL 090707.pdf HealthCare.gov. (n.d.). Glossary. Retrieved from https://www.healthcare.gov/glossary National Council on Patient Information and Education. (n.d.). Understanding prescription assistance programs (PAPs). Retrieved from http:// www.bemedwise.org/documents/paps.pd