Glossary of Terms

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A

Advanced Beneficiary Notice (ABN)A notice that you could receive if Medicare is expected to deny payment. You may be responsible for the cost of services that Medicare does not cover.1

Adverse EventAn unexpected medical issue, such as a side effect, that occurs during or following a treatment. May also be called an adverse effect or an adverse reaction.2,3

Allowable ChargesThe dollar amount that an insurance company will pay for something like a medical visit or procedure.1

AnemiaWhen your blood has a low number of red blood cells or when the red blood cells don’t have enough hemoglobin, which is the protein that helps carry oxygen through the body.4,5

Annual MaximumThe maximum amount that an insurance company will cover for each patient per year. This may be a dollar amount, or it can be a limit on the number of treatments that insurance will cover.6

AppealIf your insurance company denies payment for a service or medicine, you or your doctor can file an appeal, a written notice to the insurance company stating that you and your doctor disagree with the decision to deny the service or medication coverage and providing medically justified reasoning.1

B

Benefit DesignA list of the services or medicines an insurance company will or will not cover. This may also be called a benefit plan design or benefit design plan.1

Benefit Investigation (BI)An inquiry to see what an insurance company will cover. Can be completed by a specialty pharmacy or hub (such as TOGETHER with TESARO™). This will provide the patient's cost-sharing responsibility. May also be called a benefit verification.7

BiomarkerAn indicator that can be used to measure your body’s response to a treatment, track a disease, or imply normal or abnormal health states. For example, a person who inherits certain mutations (changes) in a BRCA1 gene has a higher risk of getting breast, ovarian, prostate, and other types of cancer.8,9

Biomarker StatusState of a biomarker. For example, in ovarian cancer, BRCA mutation is a biomarker that may be described as BRCA-positive or BRCA-negative.8,10,11

Breast Cancer Susceptibility Gene (BRCA)(pronounced bracka or B-R-C-A) – Refers to particular genes that produce proteins that suppress tumors. BRCA proteins help repair damaged DNA in cells. You may hear the terms BRCA1 and BRCA2 proteins. Mutations in BRCA may mean that it no longer functions. A BRCA gene mutation can be inherited from a parent. When this happens, it is known as a germline BRCA mutation (gBRCA). When there is a mutation in BRCA that is not passed from a parent to a child, it is called a somatic BRCA (sBRCA) mutation. See also BRCA Mutation, BRCA-negative, and BRCA-positive.9,11-13

BRCA MutationAn alteration or change in the BRCA gene. See also BRCA, BRCA-negative, and BRCA-positive.9

BRCA-negativeThis means a change (also called a mutation) is not present in the BRCA gene. A person without a mutation in the BRCA gene can still develop cancer. This may also be called wild type. See also BRCA.11,14

BRCA-positiveThis means a change (also called a mutation) has been noted in the BRCA gene. A positive result does not mean that cancer will occur, but this puts you at a higher risk for certain cancers. See also BRCA.9,11

Bridge ProgramA manufacturer-sponsored program that is designed to provide a limited free supply of medicine for eligible patients in case of an interruption in insurance coverage. The program is intended to prevent missed doses. May also be called bridge shipment.7

C

CarrierThe company that provides your health insurance. This may also be referred to as insurer, insurance company, or payer.1

Case ManagerAn expert in various types of resources, generally related to your healthcare. Resources can be financial, emotional, or practical. For example, a case manager at TOGETHER with TESAROTM could help you understand your options and the support for which you may be eligible.7

Co-insuranceYour share of a covered cost of your medical or pharmacy bill. It is usually a percentage. For example, your insurance may cover 80% of a treatment, so you will cover the remaining 20%.1

Complete Blood Count (CBC)Measures the cells in your blood, including red blood cells, white blood cells, and platelets. You will have regularly scheduled CBCs during treatment to help your doctor know if you need to change your dose of ZEJULA. This may also be called a blood count.14,15

Coordination of BenefitsIf you have 2 insurance companies, this process determines who pays for which portion of a claim.1

Co-payA fixed amount that your insurance requires you to pay for a specific service or treatment. For example, your insurance may require you to pay a certain amount when you visit your healthcare team. Your insurance will cover the amount that remains. This may also be called co-payment.16

Co-pay AssistanceA program run by independent third-party nonprofit organizations that is designed to help cover the co-payment for a medicine. In some cases, this is a program designed for people with Medicare or Medicaid who are not eligible for commercial co-pay assistance programs.

Cost SharingThe portion of your medical, pharmacy, or healthcare bill that you pay. This could include a co-payment, deductible, or co-insurance.1

D

DeductibleThe specified amount that you must pay for services or procedures before your insurance company contributes.17

DenialA decision made by your insurance company that a service or treatment is not covered. This is usually communicated in a letter to you or your healthcare team. This decision may be based on eligibility criteria.1,18

Dose AdjustmentYour healthcare team may adjust your dose of ZEJULA based on how you feel or the results of your lab work. This may also be called a dose modification or dose reduction.14,19

Double-blind, placebo-controlledIn a double-blind, placebo-controlled trial, some participants are given the treatment, while others are given a placebo (sugar pill). Neither the researchers nor the participants know which treatment the participants receive until the trial has ended, which is why they are referred to as “blind.” This is the gold standard for clinical trials because it minimizes the chance of a therapeutic effect being detected when no effect is present.

E

Eligible/EligibilityA medical cost that an insurance plan pays for or covers. This can also refer to meeting the criteria set forth by an assistance program.1,7

ExcludedA medical cost that an insurance plan does not cover.1

Explanation of Benefits (EOB)Details about the costs of a medical treatment or service that you have received. The insurance company sends these details after you have received the service. The EOB is a summary of benefits that usually includes details about the cost of the service and how much your insurance plan will pay for the procedure. It is not considered a bill.20

F

Food and Drug Administration (FDA)An agency in the US federal government responsible for protecting public health. One of these responsibilities is to approve medications based on safety and how well they work.21

H

Health Insurance Portability and Accountability Act (HIPAA)A law that, among other things, protects the privacy of patients.22,23

Health PlanThe organization that provides and manages your medical insurance. This may also be called insurer or payer.1

Hematologic Abnormality in CancerAn abnormality in the blood of a cancer patient. This can include manifestations such as anemia, leukocytosis, or thrombocytosis and is typically observed in advanced cancers.24

HubA patient resource provider that can help prescribers and patients access medication.

I

In NetworkA list of providers, hospitals, and healthcare professionals preferred by your health plan or insurer. You may have a lower co-pay if you choose from this list.25

Insurance CompanyThe organization that provides and manages your medical and prescription drug insurance. This may also be called insurer, health plan, or payer.1

L

Lifetime MaximumA limit in the total amount of reimbursement that your insurance will pay for you throughout the term of the policy.25

M

Maintenance TreatmentA treatment given to a patient after cancer has responded to initial therapy. Maintenance treatment may extend the time of that response.26

MedianThe middle number in a set of data, also called the midpoint. It means that half of the numbers are greater than the median and half are less.27

MindfulnessA way to help reduce stress by focusing your attention on the present moment and accepting your thoughts and feelings without judgment.28

N

NeutropeniaHaving fewer white blood cells (neutrophils) than the normal range, which can put you at greater risk for infection.29,30

O

Off-label UseUsing a prescription medicine to treat a disease or condition that the medicine is not approved to treat by the FDA.31

Out-of-Network (OON) BenefitA request to your insurance company asking to pay for a service or treatment that is not included in your plan. This may be done verbally or by completing a form.1

Out of Pocket (OOP)The healthcare costs that you are responsible for paying.1

P

Package InsertAlso known as the prescribing information, this is an official document that is provided with every prescription medicine. The package insert explains what you need to know about a medicine, including who should take it, what it treats, how it works, how to take it, and what to expect from treatment.32

PARP Inhibitor/PARP-1 and PARP-2 InhibitorPARP, or poly(ADP-ribose) polymerase, is a family of proteins that helps repair damaged DNA in cells. A PARP inhibitor like ZEJULA may prevent cancer cells from repairing their damaged DNA, which can cause cancer cells to die. This may slow the return or progress of cancer. ZEJULA can also impact other cells and tissues in the body.14,33,34

Patient Access Program (TOGETHER with TESAROTM)A program that helps eligible prescribers and patients access TESARO medication. TOGETHER with TESARO is an example of a patient access program. This may also be called a hub.

Patient Assistance Program (PAP)A program designed to support uninsured or underinsured patients. These programs typically have eligibility criteria, which may vary. If eligible, an individual may receive free medication based on approval. The pharmaceutical manufacturer funds this program.7

Patient Care CoordinatorAn individual who deals directly with patients and healthcare providers to improve the overall patient care and experience.

PayerThe organization or group responsible for covering your medical and pharmacy costs. This may also be called health plan, insurance company, or insurer.1

Personal Health Information (PHI)Private data, including but not limited to your full name, address, medical history, and test results, that your healthcare team or health insurance company collects. These data can be used to identify an individual. PHI is subject to HIPAA regulations.1

PharmacistA licensed healthcare provider who is trained to prepare prescription medicines and is focused on the safe and effective use of medication. If you have any questions about your medicine, your pharmacist is a good person to ask.35

Pharmacy Benefit Manager (PBM)A third-party administrator (TPA) of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D, Federal Employees Health Benefits Program, and state government employee plans. PBMs are primarily responsible for developing and maintaining the drug formulary (a list of drugs covered), working with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims.

Pharmacy TechnicianTrained personnel who perform pharmacy-related functions, generally working under the direct supervision of a licensed pharmacist.

Platelet CountA lab test that measures the number of platelets in your blood. Platelets are cells that help your blood to clot. This test is part of the blood count or complete blood count.15,36

Platinum-based ChemotherapyA type of chemotherapy used to treat ovarian cancer that contains the metal platinum, such as carboplatin and cisplatin.37,38

PremiumThe amount that you pay for your health insurance coverage.39

PrescriberThe healthcare provider who wrote the prescription for your medicine or treatment.

Prior Authorization (PA)A process used by health insurance companies in the US to determine if they will cover a prescribed procedure, service, or medication before services are rendered.25

Progression-free Survival (PFS)The length of time during and after treatment that you live with cancer but it does not get worse.40

Q

Quick-start ProgramA manufacturer program designed to provide a free, limited supply of medication in the event that there is a delay in obtaining insurance coverage at the beginning of your treatment.7

R

Red Blood CellsBlood cells that carry oxygen throughout the body. It is one of the cells that is reviewed as part of a complete blood count (CBC) test.41

ReferralA recommendation from a healthcare provider that you should be examined or treated by another provider.1

ReimbursementThe amount that your health insurance company pays back to you or your doctor for approved medical expenses.25

ResponseHow cancer reacts to treatment. If some but not all of the cancer has disappeared, it is a partial response or remission. If there are no remaining clinical signs (which can be monitored by your doctor through imaging tests such as computerized tomography [CT] scan, magnetic resonance imaging [MRI], or positron emission tomography [PET] scan) of cancer, it is considered a complete remission, although cancer still may be in the body.42,43

S

Self-managementDoing what is necessary to effectively manage your health.

Self-monitoringKeeping track of your own day-to-day health, including how you’re feeling, when you take your medicine, and any symptoms or side effects that you may experience. This information can help your doctor to better understand how you are doing.

Specialty MedicationMedicine or treatments that are not available from a traditional pharmacy. Often, these are drugs that require more supervision and monitoring or special handling.

Specialty PharmacyA type of pharmacy that deals with specialty drugs. It will often work with your insurance company to help you obtain coverage for your medication or will research financial assistance options. Once insurance coverage or financial assistance is secured, the pharmacy will contact you to schedule the shipment of your medication to your home or doctor's office. This pharmacy will provide additional support services to help you manage your treatment, such as a nurse to follow up with you about your blood work and other clinical monitoring.

T

ThresholdA set point or level at which something begins or changes.44

ThrombocytopeniaWhen the number of platelets in your blood is lower than the normal range. Platelets are needed to help your blood to clot. If your platelet level is low, you may experience bruising or bleeding more often.36,45

TOGETHER with TESAROTESARO, the company that developed ZEJULA, offers this free patient resource program to help with access issues related to ZEJULA. TOGETHER with TESARO looks into your insurance coverage and can provide guidance on your health plan’s insurance processes for treatment coverage. TOGETHER with TESARO is an example of a patient access program.

U

Usual, Customary, and Reasonable (UCR) ChargesThe amount that doctors charge for a specific medical treatment based on average rates for similar services in the area where you live.46

W

Watch and WaitA way to monitor your health that may use regular exams and lab tests instead of medicine or medical treatments. This may also be called "observation."47 

White Blood CellsBlood cells that, among other things, help the body fight infection. It is one of the cells that is checked as part of a complete blood count (CBC) test.48

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