Pharmacy Operations and Insurance Coverage
average price at which drugs are purchased at
the wholesale level.
What is AWP? (Average Wholesale Price)
a complete list of items such as property, goods
in stock, or the contents of a building.
What is Inventory?
A federal and state assistance program that pays
for health care services for people who cannot
afford them
What is Medicaid?
durable medical equipment
What is DME?
to check the accuracy of financial accounts and
records
What is Audit?
the sharing of expenses by the policyholder and
the insurance company.
What is Coinsurance?
the amount of time the average drug inventory
will be replaced during a 12-month period; most
pharmacies replace inventory every two to four
weeks
What is Inventory Turnover Rate?
a United States federal-government program
to subsidize the costs of prescription drugs
and prescription drug insurance premiums for
Medicare beneficiaries.
What is Medicare—Part D Prescription Drug Coverage?
consumable, disposable items that can only be
used by one patient for a specific purpose
What is Nondurable medical supplies?
a transaction returned through a credit card processing interchange by an issuer to an acquirer.
What is Charge Back?
coordination of benefits
What is COB ?
the total value of the entire stock of products on
hand for sale on a given day
What is Inventory Value?
Pharmacy Benefit Manager
What is PBM?
Medicare part D coverage gap
What is Donut Hole?
net sales - cost of goods sold
What is Gross Profit?
The portion of the cost of a prescription that the
patient is responsible for paying when a part of
the cost is covered by a third-party payer.
What is Copayment (copay)?
Purchasing items as needed or
What is JIT purchasing?
a formulary provided by an insurance compa-
ny that indicates preferred prescription generic
and brand name drugs and their corresponding
co-pays
What is Preferred drug list?
insurance coverage in which a patient pays one
co-pay for brand name drugs and a lower co-pay
for generic drugs
What is Dual copay?
the difference between the purchase price and
the selling price; also called gross profit
What is Mark Up?
Amount you must pay before you begin receiving
any benefits from your insurance company
What is Deductible?
a record that tracks the quantity of, and cost as-
signed to, inventory items as they are purchased
and sold
What is Perpetual Inventory Record?
approval for cover- age of a high-cost medication
or a medication not on the insurer's approved
formulary
What is PA?
a practice that occurs when a patient is paid
cash by an individual to illegally purchase pseudoephedrine from more than one pharmacy
What is Smurfing?
real-time insurance claims processing via wireless telecommunications
What is Online Adjudication?