Pharmacy Operations
This process is used to determine the order in which multiple insurance policies will pay for a claim.
PBM (Pharmacy Benefit Manager)
The difference between the purchase price of an item and its selling price, also known as the gross profit.
Mark Up
A United States federal program that subsidizes prescription drug costs for people with Medicare.
Medicare- Part D Prescription Drug Coverage
The illegal act of using multiple pharmacies to purchase pseudoephedrine for the purpose of manufacturing methamphetamine.
Smurfing
A legal program that provides insurance coverage for prescription drugs to senior citizens and certain disabled individuals.
Medicare
A fixed amount that the patient must pay for a prescription or medical service, with the remainder covered by insurance.
Copayment (Copay)
The amount of time it takes for a pharmacy’s average inventory to be replaced over the course of a year.
Inventory Turnover Rate
A gap in Medicare Part D where beneficiaries must pay more out of pocket for prescription drugs before getting additional coverage.
Donut hole
An insurance plan’s list of drugs that are preferred for coverage, including generics and brand-name medications.
Preferred Drug List
A practice where an issuer of a credit card transaction returns a payment to the acquirer due to a dispute or error.
Chargeback
A system where insurance claims are processed in real-time using wireless communication.
Online Adjudication
The practice of purchasing items only as needed, minimizing stock levels to reduce overhead.
JIT Purchasing
The amount a person must pay out of pocket for healthcare services before their insurance begins to cover the costs.
Deductible
A federal and state program that provides healthcare services for low-income individuals, including medical supplies.
Medicaid
A process in which a high-cost medication or one not on the insurer’s approved list is reviewed for approval.
PA (Prior Authorization)
This term refers to the practice of reviewing and verifying the accuracy of financial records.
Audit
A system that tracks inventory levels and costs in real time as items are purchased and sold.
Perpetual Inventory Record
A health insurance structure where the patient shares healthcare costs with the insurer as a percentage, after meeting their deductible.
Coinsurance
The total value of the entire stock of products available for sale in a store or pharmacy on a given day.
Inventory Value
The process of transferring information from a journal entry into a ledger account.
Posting
A type of medication that is disposable and typically used by a single patient for a specific purpose.
Non-durable Medical Supplies
This financial term represents the total profit made from sales before any operating expenses are deducted.
Gross Profit
This process is used to determine the order in which multiple insurance policies will pay for a claim.
COB (Coordination of Benefits)
Items such as wheelchairs or oxygen tanks that are intended for long-term use by patients.
Durable Medical Equipment (DME)
The price at which drugs are bought at the wholesale level and used as a reference for determining drug prices.
AWP (Average Wholesale Price)