not a separate benefit, but rather the part of Medicare policy that allows private health insurance companies to provide Medicare benefits.
Average Wholesale Price; it is used by pharmacy benefit managers and health insurance companies to calculate drug product reimbursement rates.
Numeric system to identify drug products in the United States. A drug’s NDC number is often expressed using eleven digits in a 5-4-2 format (xxxxx-yyyy-zz) where the first five digits identify the manufacturer, the second four digits identify the product and strength, and the last two digits identify the package size and type
Drug that, by law, can be obtained only by prescription and bears the label, “Caution: Federal law prohibits dispensing without a prescription” or “Rx Only.”
one large pharmacy that packages medications and delivers them to smaller pharmacies for distribution to patients.
a drug sold by a drug company under a specific name or trademark that is protected by a patent and is typically more expensive than the generic version.
a specialty pharmacy dedicated to the compounding and dispensing of radioactive material for use in nuclear medicine procedures.
The process of evaluating prescribing patterns, and/or patient drug utilization against predetermined standards (e.g., treatment guidelines) to determine the appropriateness of drug therapy. Sometimes called drug use evaluation (DUE). There are three types: prospective (before pre-scription dispensing), concurrent (at point of dispensing), and retrospective (after a prescription is filled).
covers certain physicians’ services, outpatient care, medical supplies and preventive services.
A unique 10-digit identifier issued to healthcare providers by the Centers for Medicare and Medicaid Services for billing purposes.
A systematic approach to providing care to a population of patients with a specific disease. Patient and provider education, pharmaceutical care, continuous quality improvement, practice guidelines, patient monitoring, outcomes assessment, and case management may be included; however, program features vary widely.
The process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.
Terminology that is used to describe intentional misrepresentation, overutilization or in-appropriate utilization, and inconsistent practices with respect to recognized standards of care for healthcare services resulting in additional costs.
The study of how genes affect a person’s response to drugs. This field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that will be tailored to a person’s genetic makeup. Also known as “personalized medicine.”
United States law was designed to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals, and other healthcare providers.
a drug that has the same active-ingredient formula as a brand-name drug that usually costs less.
Standard medical codes used for medical, surgical, radiology, laboratory, and diagnostic procedures and services.
a fixed cost defined in the insurance policy that is paid by the insured person each time a medical service is rendered.
a group of pharmacies owned by a corporate entity all under the same name.
Amount that a member pays out of pocket before coverage begins.
Medical classification system which uses standard codes for diseases, signs and symptoms, and diagnoses.
the party to a medical benefits contract that may collect premiums, assume financial risk, pay claims and provide other administrative services.
a community (retail) pharmacy that is not directly affiliated with any chain of pharmacies and is not owned by a publicly-traded company.