A – F
G
– O
P
– Z
A
– F
Academic Detailing of Prescribers
Fact-based information about prescription drugs provided by credentialed
clinicians to physicians and other prescribers. Traditional “detailing”
refers to the process pharmaceutical manufacturer sales representatives
use to promote their brand-name drugs.
Actual Rebate Amount Per Mail Script
Actual dollar amount of rebate for each mail-service prescription.
Actual Rebate Amount Per Retail Script
Actual dollar amount of rebate for each retail prescription.
Annual Deductible
Amount a plan member pays before reimbursement begins.
Annual Out-of-Pocket (OOP) Limit
The cap on the total amount a plan member pays.
Average Wholesale Price (AWP)
The published or suggested cost of pharmaceuticals charged to a
pharmacy by a large group of pharmaceutical wholesalers. The AWP
is the basis for most third-party prescription reimbursement. It
is analogous to a sticker price on a new automobile. Pharmacies
do not pay for their drugs using the AWP. A markup of wholesale
acquisition cost (WAC) is the current method.
AWP Discount % – (AWP Minus X%)
The negotiated amount a drug plan pays to pharmacies for the ingredient
cost of a prescription and commonly expressed as a percentage off
of Average Wholesale Price.
Biotech Drugs (Specialty Drugs)
Drugs manufactured through biologic processes to treat chronic,
complex or life-threatening conditions. Also called specialty drugs.
Brand Drug
Prescription drug covered by patent exclusivity.
Claritin®
OTC nonsedating antihistamine used to treat allergies. Claritin®
was only available as a prescription drug before its OTC conversion
in 2002.
Copayment Relief or Waivers
Reduced or zero-dollar copayments commonly used as incentives for
plan members to use generic drugs and adhere to medication regimens.
Diabetic Supplies
Medical materials used for treatment of diabetes, specifically glucose
meter strips, syringes, and needles.
Disease Management
A systematic approach to providing care to a population of patients
with a specific disease. Patient and provider education, pharmaceutical
care, continuous quality improvement, practice guidelines, patient
monitoring, outcomes assessment, and case management all play key
roles in disease management.
Dispensing Fee
Contracted amount in a traditional third-party prescription plan,
usually in the $2.00 to $3.00 range, that is paid to the pharmacy
in addition to the negotiated ingredient cost of the prescription.
Dollar Limit on Coverage
Price cap for amount of money plan will pay for prescription benefit.
Dose Optimization
Pharmacist-driven program to ensure patients are taking the best
dosages and strengths of a given medication to manage costs of drug
therapy.