Actions
A challenge on a reimbursement from a PBM or insurance provider on a prescription claim that has been previously processed
What is Audit?
A formulary provided by an insurance company that indicates preferred prescription generic and brand name drugs and their corresponding copays.
What is Preferred Drug List?
A state governmental health insurance program for low-income and disabled citizens.
What is Medicaid?
The entire stock of products on hand for sale at a given time.
What is Inventory?
The accumulation of all sales receipts before deducting expenses.
What is Gross Profit?
The process of reconciling an invoice and updating inventory at time of receipt of stock delivery.
What is Posting?
Real-time insurance claims processing via electronic wireless telecommunications.
What is Online Adjudication?
A federal and state partnered insurance program that provides partial coverage of prescriptions, primarily for patients who are eligible for Medicare
What is Medicare Part D?
The amount of time the average drug inventory will be replaced during a twelve month period; most pharmacies replace inventory every two to four weeks.
What is Inventory Turnover Rate?
The average price that wholesalers charge the pharmacy for a drug, serving as the benchmark price to estimate reimbursement rates and retail price without insurance.
What is Average Wholesale Price(AWP)?
A rejection of a prior prescription claim by a PBM or an insurance provider that must be investigated and resolved
What is Charge-back?
A temporary period in Medicare Part D when you pay more for prescription drugs
What is Donut Hole?
A company that administers drug benefits for many insurance companies.
What is Pharmacy Benefit Manager(PBM)?
A record that accounts for each unit of Schedule II drug dispensed or received.
What is Perpetual Inventory Record?
The difference between the acquisition cost and the selling price; also called gross profit
What is Markup?
A percentage-based insurance plan in which the patient must pay a certain percentage of the prescription price; commonly used in high-cost specialty drugs.
What is Coinsurance?
Insurance coverage in which a patient pays one copay for brand name drugs and a lower copay for generic drugs; also known as two-tier
What is Dual Copay?
Medically necessary, reusable equipment such as nebulizers, hospital beds, wheelchairs, and walkers that may be purchased in a community pharmacy or billed to Medicare Part B.
What is Durable Medical Equipment(DME)?
Frequent purchasing in quantities that just meet supply needs until the next ordering time.
What is Just-in-Time(JIT) purchasing?
The amount that the patient is to pay for each prescription as determined by the insurance carrier
What is Copayment(Copay)?
Online billing of both a primary and a secondary insurer.
What is Coordination of Benefits(COB)?
Approval for coverage of a high-cost medication or a medication not on the insurer's approved formulary obtained after a prescriber calls the insurer to justify the use of the drug; must be obtained before the drug is dispensed by the pharmacy to be covered by insurance.
What is Prior Authorization(PA)?
Disposable/short lifespanned medical supplies.
What is Nondurable Medical Supply?
The total value of the entire stock of products on hand for sale on a given day.
What is Inventory Value?
An amount on some insurance plans that must be paid by the insured person before the insurance company considers paying its portion of a medical or drug cost
What is Deductible?