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CGM
Continuous Glucose Monitor
Automatically tracks blood glucose levels throughout the day and night, through a sensor placed under the skin.
EOC
Episode of Coverage
An episode of coverage includes all of the information associates with an instance of pharmacy coverage:
Presciber's Information
Member's Information
Medication dose
Medication Name
MAPD
Medicare Advantage Prescription Drug
Includes Parts C and D
NDC
National Drug Code
An 11-digit code for an FDA approved drug/product.
PAC
Pre-Authorization Claim
When a claim processes with a prior authorization, the claim status will return as PAC.
DAW
Dispense as Written
A code submitted with each claim. This tells the pharmacists not to suggest a generic, alternative, or other dosage.
FDA
Food and Drug Administration
Government agency that ensures products are labeled accurately with information that people need to use them properly.
MDL
Maximum Dispensing Limit
Limits set to ensure appropriate and label use of some drugs
NF
Non-Formulary
Drugs which are not included on the Pharmacy plan approved list.
PDP
Prescription Drug Plan
Medicare's voluntary plan which covers for prescription plan.
DEA
Drug Enforcement Agency
Government agency responsible for laws surrounding the distribution of controlled substance prescriptions.
GCN
Generic Code Number
A five-digit code assigned to every drug based on its chemical makeup and dose.
MOOP
The most a member has to pay for covered services in a plan year.
NPI
National Provider Information
Unique identification number associated with a specific provider/group.
QL
Quantity Limit
QL are set on some drugs to ensure safety and appropriate use of medications.
DOS
Date of Service
This is the prescription's Date of Fill (DOF)
LTC
Long Term Care
MDO
Medical Doctor's Office
The prescribing doctor's office.
OTC
Over the Counter
An over-the-counter medication is safe and effective to use without a doctor's prescription.
QTY/DS
Quantity and Days' Supply
AF
Auto Forward
When an appeal to cover a health service/item is denied it automatically forwards the appeal to the next level, the independent Review Entity.
Hospice
A special way of caring for people who are terminally ill that includes physical care for the patient
MYB
Maximize Your Benefit
An outbound call group that contacts members who are taking high-cost medications to suggest lower cost alternatives.
PA
Prior Authorization
A PA is an authorization that is obtained from insurance before a medication can be covered by the member's plan.
RTS
Refill Too Soon