The terms “Average Wholesale Price” or “AWP” or any reference thereto, shall mean the average value at which wholesalers sell drugs to physicians, pharmacies, and other customers. AWP is the generally accepted standard measure for calculating the cost of a particular medication.

The term “Brand Drug” or any reference thereto, shall mean a prescription drug that is marketed with a specific brand name by the company that manufactures it and is protected by a patent, usually held by the company that manufactures it.  Brand Drugs are typically much more expensive than their Generic Drug counterparts.

The term “Generic Drug” or any reference thereto, shall mean a medication created to be the same as an already marketed brand drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use.  Generic Drugs are typically much less expensive than their brand drug counterparts.

The term “Legend Drugs” or any reference thereto, shall mean those drugs that, by law, cannot be dispensed by a pharmacy without a prescription from a physician or dentist.  These may include, but are not limited to insulin, diabetes management supplies, chemotherapy drugs, and other drugs used to treat chronic conditions.

A Letter of Medical Necessity, more commonly referred to as a “LMN,” is a written request made by your doctor and submitted to Proscript, explaining why it is medically necessary for you to be on a particular type or brand of medication.  A LMN is required for all specialty drugs, injections, ADHD medications, certain brand medications, and contraceptives.  One of the reasons this letter is required is to ensure it is covered by your plan.  There are also some medications that require the patient’s most recent medical records, lab work, and/or treatment plan, in addition to a LMN, in order for that prescription to be filled.