Prescription Life Cycle
A series of stages through which something passes during its lifetime.
What is a Life Cycle?
Administers the pharmacy benefit for a client/plan sponsor.
What is a Pharmacy Benefit Manager?
To standardize the exchange of healthcare information to improve outcomes.
What is the NCPDP Purpose?
We make medications more affordable for the people who need them, so they can live their lives more fully
What is Navitus’ Mission Statement?
One cycle last two to four weeks.
What is the Sprint?
The three players in the PBM world.
Who is the patient (Member), the pharmacy, and the client?
Fully-owned subsidiary of Navitus located in Madison, WI.
What is Lumicera?
They develop standards documents and specifications with members meeting four times per year.
What are Work Groups?
A full disclosure business model where all rebates, discounts, and coupons received are given back to the Client.
What is 100% Pass-Through?
Acts as the facilitator between the Product Owner and the Development Team.
Who is the Scrum Master?
Navitus receives their drug information/pricing from this vendor.
Who is Medi-Span?
The physical documented list of the drug names and associated information.
What is a formulary?
They work on specific issues within a Work Group and provide recommendations.
What is a Task Group?
Site that contains a central repository of company wide information.
What is Compass?
The Development Team members demo the product with the Product Owner and feedback and suggestions are given.
What is the Sprint Review?
This organization sets the Standards for the Pharmacy industry.
Who is NCPDP?
Drug products are evaluated on these four pieces of criteria.
What is effectiveness, side-effects, drug interactions, value (cost)?
The acronym meaning of DERF.
What is Data Element Request Form?
Access to complete transcript/development tasks assigned and sign up/complete courses, such as LinkedIn or Lunch N Learns.
What is PALS (Performance and Learning Services)?
The Product Owner provides the highest priority items to the Development Team and they decide what can be completed for the Sprint and create tasks.
What is Sprint Planning?
Navitus’ administration fee for providing pharmacy benefits.
What is Per-Member Per-Month (PMPM)?
Make recommendations for formulary placement, utilization tools, quantity limits, Prior Authorizations, and Drug Utilization Review criteria.
What are the responsibilities of the Pharmacy and Therapeutics (P&T) committee?
Develops and maintains standards and guidelines to accommodate the collection, transmission, and processing of electronic pharmacy claim information, i.e., administering and certifying eligibility, prior authorization, and prescribing drug benefits for traditional, managed care, and government programs; billing; payment or denial of compensation with explanations, and concurrent drug use review.
What is Work Group 1 Telecommunications? (Really means “A pharmacy claim sent to Navitus and response from Navitus to pharmacy.)
Contains company-wide policies and procedures so when a specific question comes up it can be referenced.
What is the Navitus and Lumicera Employee Handbook?
Discussion to evaluate and decide what worked and didn’t work in order to improve the next Sprint.
What is Sprint Retrospective?