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pankit 151/153

Reimbursement for Pharmacy Services.

QuestionAnswer
AWP ( Average Wholesale Price) the cost of drugs and pharmacueticals purchased from drug wholesaler.
MAC ( Maximum Allowable Cost) based on wholesaler acquisition cost.
Wholesaler Acquisition Cost include contracts negotiated between the provider and the pharmacuetical industry.
Prior approval the prescriber must demonstrate evidence for anindividual patient's need for a medication outside the approved formulary for it to be reimbursed
The evidence to grant prior approval for nonformulary drugs usually must indicate. 1.Patient intolerance of existing drug choices.2.Treatment Failures.3.Diagnoses without any listed treaments on the formulary.4.New drug modalities.
Open Formulary plans. Reimburse all prescription medication.
Closed formulary plans. only reimburse a list of medications , generally low- cost alternatives.
Copay Plans divide the cost of coverage between the insurer and the patient.
Who has $4.00 Formulary? Wal-Mart.
Created by: pankitpatel
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