Across
- 4. Pharmacies may join a group purchasing organization (GPO) and contract directly with the manufacturer to obtain better pricing
- 5. The amount paid by a policyholder out of pocket before the insurance company pays a claim
- 6. Tight restriction of medication use to the medications included on the formulary list; medications that are not listed as preapproved drugs per the health plan provider or pharmacy benefits manager are not reimbursed except under extenuating circumstances and with proper documentation
- 9. The process used by Medicare and Medicaid for authorization of assistive technology devices costing more than $100; durable medical equipment (eg, wheelchairs and walkers) also require a TAR; similar to a preauthorization form
- 12. A type of insurance in which the policyholder pays a share of the payment made against a claim
- 13. A large distributor of medications and retail products that contracts with the pharmacy to deliver the bulk of their medications in exchange for lower prices; examples of prime vendors are McKesson, Cardinal Health, and AmerisourceBergen
- 16. The portion of the prescription bill that the patient is responsible for paying
- 17. An insurance plan that allows coverage for in-network only physicians and services and uses the primary care physician (or provider) as the “gatekeeper” for the patient's health care; patients often have copays to defray the costs of medical care and prescription drugs
- 20. A list of preapproved medications that are covered under a prescription plan or within an institution
- 24. Federal guidelines for the protection of a patient's personal health information
- 26. AKA brand, or proprietary drug name The name a company assigns for marketing and identification purposes to a commercial drug product; most brand names are trademarked and belong to originator products; the named products are often protected for a time by patents
- 28. 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
- 29. A government-managed insurance program composed of several coverage plans for health care services and supplies; it is funded by both federal and state entities, and individuals must meet specific requirements to be eligible; individuals must be 65 years or older, be younger than 65 with long-term disabilities, or suffer from end-stage renal disease
- 30. A document listing necessary patient personal and health information, including comprehensive information on the medications the patient is taking, disease states, and any food or drug allergies the person might have
- 32. Supplemental insurance provided through private insurance companies to help cover costs not reimbursed by the Medicare plan, such as coinsurance, copays, and deductibles
- 33. Insurance-required approval for a restricted, nonformulary, or noncovered medication before a prescription medication can be filled
- 34. A system that allows inventory to be tracked as it is used
Down
- 1. A government-managed insurance program that provides health care services to low-income children, the elderly, blind, and those with disabilities
- 2. An insurance plan in which patients choose a provider from a specified list, resulting in reduced costs for medical services
- 3. The average price at which a drug is sold; the data are compiled from information provided by manufacturers, distributors, and pharmacies; the AWP is often used in calculations related to medication reimbursement
- 7. A number assigned to any health care provider that is used for the purpose of standardizing health data transmissions
- 8. Government-required and government-enforced medical coverage for workers injured on the job, paid for by the employer; the programs are managed by each state in accordance with the state's workers' compensation laws
- 10. Information sheets supplied to the pharmacy from the manufacturer of chemical products; the SDS lists the hazards of the product and procedures to follow if a person is exposed to that product
- 11. Medical staff composed of physicians, pharmacists, pharmacy technicians, nurses, and dieticians who provide necessary information and advice to the institution or insurer on whether a drug should be added to a formulary
- 14. A system that orders a product just before it is used
- 15. The PAR of stock levels to a certain number of allowed units
- 18. Program of the Department of Veterans Affairs (CHAMPVA) A program for veterans with permanent service-related disabilities and their dependents and for the spouses and children of veterans who died of service-connected disability; also known as the Veterans Health Administration (VHA)
- 19. The enactment of prescription drug coverage provided for individuals covered under Medicare
- 21. An ongoing review by a pharmacist of the prescribing, dispensing, and use of medications, based on predetermined criteria, to decide whether changes need to be made in a patient's drug therapy
- 22. Electronic insurance billing for medication payment
- 23. A 10-digit number given to all drugs for identification purposes; in health and drug databases, the NDC is represented as an 11-digit number, in which placeholder zeros are inserted in the proper order in the code for the purpose of standardizing data transmissions
- 25. A health benefit program for active duty and retired personnel in all seven uniformed services; it also covers dependents of military personnel who were killed while on active duty
- 27. Companies that stock a variety of drug manufacturers' medications and normally have a “just-in-time” turnaround for ordered drugs; this means that drugs ordered today arrive the next day
- 31. The amount of product a pharmacy has for sale