Korie Hi
Mind Map by Korie Hi, updated more than 1 year ago
Korie Hi
Created by Korie Hi over 6 years ago


financial issues

Resource summary

  1. Pharmacy benefit manager
    1. a company that administers drug benefit programs
    2. Insurance
      1. Co-insurance: an agreement between the insurer and the insured to share costs
        1. Co-pay: The patient must pay a portion of the price of the medication and the insurance company is billed for the remainder
          1. 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
            1. Deductible: a set amount that must be paid by the patient for each benefit period before the insurer will cover additional expenses
            2. Managed care programs
              1. PPOs
                1. 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.
                2. HMOs
                  1. 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
                  2. POS
                    1. 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
                  3. Programs
                    1. Medicare
                      1. 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
                      2. Medicaid
                        1. A federal state program, administered by the states, providing health care for the needy
                        2. Worker's compensation
                          1. An employer compensation program for employees accidentally injured on the job
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