To understand insurance coverage, the following key terms will be helpful.

Brand-name drugs

Drugs marketed under a trade name by the manufacturer that develops and patents them.

Generic drugs

Once the patent (or license) expires on a brand-name drug, a generic chemically equivalent version can be developed and sold at a lower cost.

Premium

Payments made by patient to maintain insurance coverage. This is a monthly payment and varies by insurance plan.

Co-payments (Co-pays)

The set fee patients pay for a covered service every time that service is provided. Co-payments vary depending on the plan. Co-payments do not count toward a deductible but do count toward the annual out-of-pocket maximum for most services. Nearly all plans have co-payments or co-insurance.

Co-insurance

The percentage of the cost the patient pays for a covered service. Co-insurances vary according to the plan and do not apply toward deductibles. However, they do count toward the annual out-of-pocket maximum for most services.

Deductible

The set amount patients must pay each contract year for covered medical services before the insurance plan begins to pay its share. Patients with a deductible will be billed for the full allowable amount for each service that is subject to the deductible.

There are two types of health insurance, private and public. Private, or “commercial” health insurance is insurance you get from your job, or insurance you buy directly from an insurance company or exchange.

Public health insurance is provided by the federal or state government. This includes Medicare, Medicaid, Veterans Health Administration/TRICARE Department of Defense.

Private and public health insurance both include the medical benefit and the pharmacy benefit.

Understanding Medicare

Medicare mainly provides coverage for people who are over the age of 65, blind, or disabled. This program pays for medical services and procedures that have been determined as “reasonable and necessary.” It is important to note that there are various parts of Medicare and benefits vary based on the type of coverage you select.

Medicaid

Covers people with low incomes and some disabled people. Funded partly by the federal government and partly by individual states.

Veterans Health Administration/TRICARE DoD (Department of Defense)

Covers people who are or have been in the military, including:

• Veterans
• Active-duty service members
• National Guard and Reserve members
• Retirees
• Families of retirees

In order for you to receive ENHERTU4U program offerings, your doctor will complete an enrollment form. If you did not sign this form at your doctor’s office, you can give authorization in 1 of 3 ways:

• Call ENHERTU4U at 1-833-ENHERTU (1-833-364-3788) to give authorization over the phone
• Print the form below and fax it to 1-866-760-5917
• Provide completed form to your doctor and they will send it to ENHERTU4U

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