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Chapter 13 Vocab
| Question | Answer |
|---|---|
| Adjudication | Electronic insurance billing for medication payment |
| Average Wholesale Price (AWP) | The average price at which a drug is sold |
| Closed Formulary | Medication use is tightly restricted to the medications provided by the formulary list |
| Co-pay | The portion of the prescription bill that the patient is responsible for paying |
| Drug Topic Red Book | Reference book listing NDC numbers, manufactures, and AWP of drug products |
| Drug Utilization Evaluation/Review (DUE) (DUR) | The process by which pharmacist ensure proper medication utilization |
| Formulary | A list of preapproved medications that are covered under a prescription plan or within an institution |
| Health Insurance Portability and Accountability Act (HIPPA) | Federal guidelines for the protection of a patients personal health data |
| Material Safety Data Sheet (MSDS) | Information sheets supplied to the pharmacy from the manufacturer of chemical products and how to handle accidental exposure to them |
| Medicare Modernization Act (MMA) | The enactment of prescription drugs covered for persons covered under Medicare and set limitations on how much they had to pay |
| National Drug Code (NDC) | 10 digit number given to all drugs for identification purposes |
| National Provider Identifier (NPI) | number assigned to any health care provider that is used for the purpose of standardizing health data transmissions |
| Open Formulary | A formulary list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and reimbursed under the health provider plan or pharmacy benefit plan |
| PAR | Periodic automatic replacement of stock levels to a certain number of units allowed |
| Patient Profile | A document listing the necessary patient personal and health information including comprehensive information on the medication they are taking |
| Pharmacy and Therapeutics Committee | Medical staff composed of physicians and pharmacist who provide necessary information and advice to an institution or insurer if a medication should be added to the formulary |
| POS | Point of Sale or Point of Service |
| Prior Authorization | Insurance-required approval for a restricted, non-formulary, or non-covered medication before a prescription medication can be filled |
| Trade/Brand/proprietary name | The name a company assigns for marketing and identification purposes to a commercial drug product |
| Treatment Authorization Request (TAR) | similar to the preauthorization form but used for Medicare and Medicaid |
| HMO | Health maintenance organization |
| Medicare | Government-managed insurance program composed of several coverage plans for health care services and supplies funded by government and state; must be 65+, younger if have long-term disability's or suffering from end-stage renal disease |
| Medicaid | Government-managed insurance program that supplements Medicare if the individual meets specific requirements; for low-income, the elderly, blind, and those with disability's |
| Medigap Plans | Supplement insurance polices provided through private insurance programs to help cover the cost not reimbursable by Medicare plan such as co-pay, co-insurance, and deducible |
| PPO | Preferred provider organization |
| Workers Compensation | Government-required and government-enforced medical coverage for workers injured on the job paid for by the employers managed by each sate depending on their work compensation laws |
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