PLEASE CHOOSE A LETTER:
To manage and resolve a claim.
Average Wholesale Price (AWP):
- Manufacturer suggested price charged by a seller when selling to retail pharmacies.
- AWP is particular to drug strength, dosage, package size, and manufacturer.
Benefit Plan Design:
The combination of temporary options selected by the client. Some of the elements of the advantage plan design for pharmacy coverage include:
- Generic options
- Pharmacy network
Programs a health plan provides to help progress the overall quality and cost of care, and are designed to compliment the health benefits program.
Only the drugs listed on the formulary are protected by the plan and thus adequate for reimbursement as outlined in the plan provisions. In the occasion the client receives a drug which is not on the formulary, the client is dependable for paying the full cost of that prescription.
The customer is required to pay a particular percentage of the cost of the prescription.
Compliance and Persistency Programs:
A positive approach to support customers to be compliant with the medications prescribed by their physician(s). A PBM or carrier may send helpful letters or email messages regarding appropriate medication use or refill reminders. Habitually these programs relate to therapeutic drugs.
Concurrent Drug Utilization Review (DUR):
Implicates a series of revises (such as: drug-drug or drug-disease interaction, drug-age, drug-gender, dosage), or criteria used to a prescription drug claim which compare information about the customer with the drug to be distributed, as well as information about the customer's other medications (if any). Computer links between the pharmacy and PBM assist in quickly identifying any DUR concerns before the medication is distributed.
The customer is required to pay a particular flat dollar amount for each prescription.
The benefit plan design will identify the portion of the medication costs for which the client is responsible for paying. Thus, the carrier and the client "share" in the cost of prescriptions.