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Introduction to Pharmacy 2- Terms for Midterm
Terms in this set (20)
Average acquisition cost (AAC)
the cost of a business to acquire a new customer.
Average wholesale price (AWP)
is a prescription drugs term referring to the average price at which drugs are purchased at the wholesale level. The term was originally intended to convey real pricing information to third-party payors, including government prescription drug programs.
is a payment arrangement for health care service providers such as physicians or nurse practitioners. It pays a physician or group of physicians a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.
Centralized pharmacy services
means the processing by a central drug outlet or central pharmacist of a request from another pharmacy to fill, refill, or dispense a prescription drug order, perform processing functions or provide cognitive or pharmaceutical care services. Each function may be performed by the same or different persons and at the same or different locations.
Decentralized pharmacy services
as a primary method for medication distribution. Practitioner orders are still processed by the pharmacy, but the medications have been moved closer to the patient.
The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay.
is a discount you give to a customer who pays on or before the discount date or within the discount grace period.
Estimated Acquisition cost (EAC)
is either the estimated cost of a product or a pharmacy's usual and customary charge.
Fee for service
is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
an official list giving details of medicines that may be prescribed.
Health maintenance organization (HMO)
is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities in the United States and acts as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis.
a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.
Managed care organization (MCO)
describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care, for organizations that use those techniques or provide them as services to other organizations, or to describe systems of financing and delivering health care to enrollees organized around managed care techniques and concepts.
Maximum Allowable Cost (MAC)
means the unit price established by the PBM for a multisource drug included on PBM's MAC drug lists developed for PBM's clients, which may be amended from time to time by PBM, in its sole discretion.
Pharmacy Benefit Manager (PBM)
is most often a third party administrator (TPA) of prescription drug programs but sometimes can be a service inside of an integrated healthcare system (e.g.: Kaiser or VA). They are primarily responsible for processing and paying prescription drug claims.
Preferred Provider Organization (PPO)
A type of health insurance arrangement that allows plan participants relative freedom to choose the doctors and hospitals they want to visit.
an amount to be paid for an insurance policy.
is the process of obtaining Physicians Plus authorization prior to the member receiving services. The purpose of the prior authorization function is for Physicians Plus to determine member eligibility, benefit coverage, medical necessity, location and appropriateness of services.
a partial refund to someone who has paid too much money for tax, rent, or a utility.
Wholesale Acquisition Cost (WAC)
as published by FDB represents the manufacturer's (for purposes of this Drug Price Policy, the term "manufacturer" includes manufacturers, re-packagers, private labelers and other suppliers) published catalog or list price for a drug product to wholesalers as reported to First Databank by the manufacturer.
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