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Chapter 13 Vocab

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Answer
Adjudication   Electronic insurance billing for medication payment  
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Average Wholesale Price (AWP)   The average price at which a drug is sold  
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Closed Formulary   Medication use is tightly restricted to the medications provided by the formulary list  
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Co-pay   The portion of the prescription bill that the patient is responsible for paying  
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Drug Topic Red Book   Reference book listing NDC numbers, manufactures, and AWP of drug products  
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Drug Utilization Evaluation/Review (DUE) (DUR)   The process by which pharmacist ensure proper medication utilization  
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Formulary   A list of preapproved medications that are covered under a prescription plan or within an institution  
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Health Insurance Portability and Accountability Act (HIPPA)   Federal guidelines for the protection of a patients personal health data  
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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  
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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  
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National Drug Code (NDC)   10 digit number given to all drugs for identification purposes  
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National Provider Identifier (NPI)   number assigned to any health care provider that is used for the purpose of standardizing health data transmissions  
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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  
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PAR   Periodic automatic replacement of stock levels to a certain number of units allowed  
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Patient Profile   A document listing the necessary patient personal and health information including comprehensive information on the medication they are taking  
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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  
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POS   Point of Sale or Point of Service  
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Prior Authorization   Insurance-required approval for a restricted, non-formulary, or non-covered medication before a prescription medication can be filled  
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Trade/Brand/proprietary name   The name a company assigns for marketing and identification purposes to a commercial drug product  
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Treatment Authorization Request (TAR)   similar to the preauthorization form but used for Medicare and Medicaid  
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HMO   Health maintenance organization  
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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  
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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  
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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  
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PPO   Preferred provider organization  
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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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