Who You Gonna Call?
This team is often the first point of contact for member and provider questions.
What is the Customer Care Team (CCT)?
The fixed amount a member pays at the pharmacy counter for a covered prescription.
What is a copay?
This outcome occurs when a PA request meets all coverage criteria.
What is an approval?
This federal law protects the privacy and security of members' health information.
What is HIPAA?
Medicare Part D launched during this decade.
What are the 2000s?
This department analyzes claims data and reporting to identify business trends and insights.
What is Data Analytics?
A member must try a preferred product first under this utilization management strategy.
What is step therapy?
This process allows a provider to request that a PA denial be overturned.
What is an appeal?
Employees are often required to complete this activity annually to maintain awareness of regulatory and organizational requirements.
What is compliance training?
The first oral contraceptive pill became widely available during this decade.
What are the 1960s?
This team manages client relationships after implementation.
What is Account Management?
High-cost generics typically fall into this formulary tier.
What is Tier 2*?
This term describes the condition or disease the medication is intended to treat.
What is an indication (or diagnosis)?
This document outlines employee expectations regarding ethics, conflicts of interest, and compliance.
What is a Code of Conduct?
DAILY DOUBLE
This decade saw the first successful use of insulin to treat diabetes.
This department negotiates manufacturer agreements and submits rebates to help reduce net drug costs.
What is Industry Relations?
Unlike generic drugs, these medications are highly similar to, but not exact copies of, a reference biologic.
What are biosimilars?
Prescribers submit these patient records to demonstrate diagnosis, treatment history, and medical necessity.
What are chart notes?
Improper billing, intentional deception, and misuse of healthcare resources are examples of this compliance concern.
What is fraud, waste, and abuse (FWA)?
The Tylenol poisonings spurred the adoption of tamper-resistant drug packaging during this decade.
What are the 1980s?
This department is responsible for generating leads and acquiring new clients.
What is Business Development?
This Ventegra committee helps ensure formulary and VSI coverage decisions are grounded in clinical evidence.
What is CAC?
When a member changes health plans, this consideration may help prevent disruption of an established therapy.
What is Continuity of Care?
Many self-funded employer health plans are governed by this federal law rather than state insurance regulations.
What is ERISA?
Pharmacists increasingly shifted from compounding medications to dispensing mass-manufactured drugs during this decade.
What are the 1950s?