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M9L2

Module 9 Lesson 2 Terms

TermDefinition
Average acquisition cost average acquisition cost to pharmacy from wholesaler.
Average manufacturer price average price paid to manufacturer by wholesaler for retail pharmacies.
Average wholesale price (AWP) price used for pharmacy pricing and reimbursement from insurance payers.
Direct acquisition cost cost the pharmacy pays for direct purchases.
Estimated acquisition cost estimated price that state Medicaid programs use for reimbursement.
Maximum allowable cost (MAC) maximum price an insurance provider or PBM will pay for generic medications.
National average drug acquisition cost (NADAC) average of medication acquisition costs from retail pharmacies.
Wholesale acquisition cost (WAC) price set by manufacturers for wholesalers.
Drug ingredient cost price a pharmacy department pays for a medication.
Dispensing fee cost to cover the pharmacy department staff labor and overhead expenses to fill a prescription and allow for a reasonable return on investment.
Usual and customary (U&C) price a patient pays for the prescription if they are buying it without submitting the claim to any insurance. It is sometimes called a cash or retail price.
Copayment specified dollar amount for every prescription received.
Tiered copayments specified dollar amount which is lower for generic or preferred medications and higher for brand-name or nonpreferred medications.
Coinsurance patients pay a specified percentage of their prescription expenses.
Deductibles require patients to pay for all their prescription expenses until a specified dollar amount has been paid out-of-pocket.
Created by: RGVCPharmily
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