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formulary tier exception

German translation: geringere Zuzahlung

GLOSSARY ENTRY (DERIVED FROM QUESTION BELOW)
English term or phrase:formulary tier exception
German translation:geringere Zuzahlung
Entered by: Diana Marloh

11:01 Feb 13, 2017
English to German translations [PRO]
Medical - Insurance
English term or phrase: formulary tier exception
In einem Fragebogen, der sich medizinisches Fachpersonal richtet:

Es geht um verschiedene MS-Medikamente, für die ein Antrag auf Kostenübernahme gestellt wurde. Hier soll das Ergebnis des Antrags angegeben werden:

Eine Antwortmöglichkeit ist: Usage granted/formulary tier exception was granted

Ich bin noch relativ neu auf dem medizischen Gebiet. Ich verstehe es so, dass es etwas mit der Arzneimitteliste (USA) zu tun hat, aber ich verstehe nicht wirklich den Begriff "tier exception". Eine Ausnahme vom Grad der Kostenübernahme des Medikaments?

Kann mir jemand helfen??

Vielen herzlichen Dank und viele Grüße!
Diana Marloh
Diana Marloh
Local time: 15:51
geringere Zuzahlung
Explanation:
"Tier" ist US-spezifisch. Erläuterung:
Typically, formularies are organized into three tiers, each having different co-pays. Tier 1 usually consists of generic drugs that are almost always covered by all plans at the lowest co-pay. Tier 2 usually consists of brand drugs that are also commonly called "Preferred", while Tier 3 represents "Non-Preferred" drugs that typically have the highest co-pays. Some formularies consist of more than three tiers and drugs in these higher tiers carry higher co-payments. Certain plan designs may require patients to "pay the difference" when a multi-source brand drug is requested, which usually results in higher out-of-pocket costs to patients.

"formulary tier exception" = Beantragung einer geringeren Zuzahlung (s. Beispielsatz und Link unten):

- mit "granted": geringere Zuzahlung genehmigt
Selected response from:

Katja Dienemann
Germany
Local time: 15:51
Grading comment
Danke!
4 KudoZ points were awarded for this answer



Summary of answers provided
3 +2geringere Zuzahlung
Katja Dienemann


  

Answers


1 hr   confidence: Answerer confidence 3/5Answerer confidence 3/5 peer agreement (net): +2
geringere Zuzahlung


Explanation:
"Tier" ist US-spezifisch. Erläuterung:
Typically, formularies are organized into three tiers, each having different co-pays. Tier 1 usually consists of generic drugs that are almost always covered by all plans at the lowest co-pay. Tier 2 usually consists of brand drugs that are also commonly called "Preferred", while Tier 3 represents "Non-Preferred" drugs that typically have the highest co-pays. Some formularies consist of more than three tiers and drugs in these higher tiers carry higher co-payments. Certain plan designs may require patients to "pay the difference" when a multi-source brand drug is requested, which usually results in higher out-of-pocket costs to patients.

"formulary tier exception" = Beantragung einer geringeren Zuzahlung (s. Beispielsatz und Link unten):

- mit "granted": geringere Zuzahlung genehmigt

Example sentence(s):
  • If your copay is high because your prescription is in a higher cost tier than other similar drugs on the formulary, you can ask your Medicare drug plan to move it to a lower tier for you. This is called a request for a formulary tier exception.
  • If your copay is high because your prescription is in a higher cost tier than other similar drugs on the formulary, you can ask your Medicare drug plan to move it to a lower tier for you. This is called a request for a formulary tier exception.

    https://www.medicareinteractive.org/get-answers/medicare-rights-and-appeals/part-d-appeals/asking-my-plan-to-lower-my-part-d-drug-copay-tier
    Reference: http://www.aerztezeitung.de/politik_gesellschaft/gesundheits...
Katja Dienemann
Germany
Local time: 15:51
Native speaker of: German
PRO pts in category: 4
Grading comment
Danke!

Peer comments on this answer (and responses from the answerer)
agree  Steffen Walter
1 hr
  -> Danke Steffen.
agree  lisa23
22 hrs
  -> Fanke Lisa.
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