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M9L2
Module 9 Lesson 2 Terms
| Term | Definition |
|---|---|
| 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. |