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Reimbursement for Pharmacy Services.
Question | Answer |
---|---|
AWP ( Average Wholesale Price) | the cost of drugs and pharmacueticals purchased from drug wholesaler. |
MAC ( Maximum Allowable Cost) | based on wholesaler acquisition cost. |
Wholesaler Acquisition Cost | include contracts negotiated between the provider and the pharmacuetical industry. |
Prior approval | the prescriber must demonstrate evidence for anindividual patient's need for a medication outside the approved formulary for it to be reimbursed |
The evidence to grant prior approval for nonformulary drugs usually must indicate. | 1.Patient intolerance of existing drug choices.2.Treatment Failures.3.Diagnoses without any listed treaments on the formulary.4.New drug modalities. |
Open Formulary plans. | Reimburse all prescription medication. |
Closed formulary plans. | only reimburse a list of medications , generally low- cost alternatives. |
Copay Plans | divide the cost of coverage between the insurer and the patient. |
Who has $4.00 Formulary? | Wal-Mart. |