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FINANCIAL ISSUES
- Pharmacy benefit manager
- a company that administers drug benefit programs
- a company that administers drug benefit programs
- Insurance
- Co-insurance: an agreement between the
insurer and the insured to share costs
- Co-pay: The patient must pay a portion of the
price of the medication and the insurance
company is billed for the remainder
- Dual co-pays: a lower co-pay apllies to prescriptions filled with
generic drugs and a higher co-pay applies to prescriptions
filled with brand name drugs that have no generic equivalent
- Deductible: a set amount that must be paid by
the patient for each benefit period before the
insurer will cover additional expenses
- Co-insurance: an agreement between the
insurer and the insured to share costs
- Managed care programs
- PPOs
- A network of providers where costs outside the network may be
partially reimbursed and the patient's primary care physician need
not be a member. PPOs offer the most flexibility for their members.
Usually require generic substitutions.
- A network of providers where costs outside the network may be
partially reimbursed and the patient's primary care physician need
not be a member. PPOs offer the most flexibility for their members.
Usually require generic substitutions.
- HMOs
- Made up of a network of providers who are either employed by the
HMO or have signed contracts to abide by the policies of the HMO.
HMOs usually will not cover expenses incurred outside their
participating network. HMOs often require generic substitution
- Made up of a network of providers who are either employed by the
HMO or have signed contracts to abide by the policies of the HMO.
HMOs usually will not cover expenses incurred outside their
participating network. HMOs often require generic substitution
- POS
- A network of providers where the patient's primary
care physician must be a member and costs outside
the network may be partially reimbursed. POSs
usually require generic substituition
- A network of providers where the patient's primary
care physician must be a member and costs outside
the network may be partially reimbursed. POSs
usually require generic substituition
- PPOs
- Programs
- Medicare
- A federal program providing health care to people with
certain disabilities or who are over the age of 65;
includes basic hospital insurance, voluntary medical
insurance, and voluntary prescription drug insurance
- A federal program providing health care to people with
certain disabilities or who are over the age of 65;
includes basic hospital insurance, voluntary medical
insurance, and voluntary prescription drug insurance
- Medicaid
- A federal state program, administered by the
states, providing health care for the needy
- A federal state program, administered by the
states, providing health care for the needy
- Worker's compensation
- An employer compensation program for
employees accidentally injured on the job
- An employer compensation program for
employees accidentally injured on the job
- Medicare
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