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Coverage and cost

  • I see the letters PA, ST, and QL by a plan selection. What do these letters mean?

    • PA stands for Prior Authorization. This means that your plan has to give authorization before it will help pay for certain medicines.
    • ST stands for Step Therapy. Some medicines may require step therapy – meaning, you may have to try a different medicine to treat your condition before your plan will cover the medicine your doctor first prescribed for you.
    • QL stands for Quantity Limits. Some medicines have quantity limits, which means that the pharmacy may only be allowed to give you exactly enough medicine to cover a certain period of time. Quantity limits are usually for very expensive medicines (so you don’t buy more than you need), or for medicines that are more likely to be overused or abused.