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Dosage / Insurance
Solid Oral Dosage and Insurance Processing
| Question | Answer |
|---|---|
| Tablets | solid dosage form which varies in size, weight, shape |
| Enteric-Coated | tablets w\ coating causing them to dissolve in intestinal tract instead of stomach |
| Buccal tablets | placed in the buccal pouch (between the gums and the cheek) and slowly dissolved, absorbed into the bloodstream directly |
| Sublingual tablets | placed under the tongue, directly absorbed into the bloodstream, bypass the intestines |
| Chewable tablets | meant to be ground before swallowing. |
| Lozenges and Troches | dissolved while held in the mouth \ intended for contact with throat\mouth over extended time. |
| Effervescent tablets | release carbon dioxide, rapidly dissolve in water. Never be swallowed\chewed. Always be placed in a water & dissolved. |
| Capsules | solid dosage form enclosed in a hard shell or soft gelatin coating, wity liquid becomes slippery and easy to swallow |
| Elixir | preparation that contains a hydroalcoholic liquid (clear color), taken orally |
| Suspension | preparation that contains tiny solid particles(not dissolved) in the liquid |
| Syrup | preparation containing concentrated sugar solution in water (w\ other active ingredients) |
| Solution | contains ingredients of a medication that are solid, these are dissolved in liquid (normally the liquid is water.) |
| Reconstitution | a med in powdered form, a suspension is made from this powder by adding a very specific amount of distilled water, important to shake, Some, after adding water, require refrigeration |
| refill too soon rejection | Generally < 75% of previous fill has been used up, close to 7 days early on 30-day supply \ 90-day supply - 21 days early |
| prior authorization rejection | insurance blocks coverage, requires prescriber to contact them |
| BIN number | number is used to identify which company reimburses the pharmacy for the medication |
| Bank Identification Number | BIN - 5 digits, tells pharmacy where claim should be sent (for THEIR reimbursement) |
| Pharmacy Benefit Manager (PBM) | company that makes its money by only handling the billing for prescriptions |
| Medicare Part D | prescription insurance coverage program of Medicare. Brand name \generic med covered at pharmacies who participate |
| “Donut Hole” | gap in coverage in Part D, what happens once costs accrue to initial coverage limit, member is responsible for paying 100% of cost, Some coverage in the donut hole is covered by certain plans. Despite - still pay less than without |
Created by:
jlauderman
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