Chapter 13 Vocab
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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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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You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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