The ABCs of Pharmacy (Rx) Benefits

Why are healthcare and pharmacy benefits SO complicated?

They don't have to be! In fact, I'm going to break down via a series of LinkedIn Posts the bajillion or so acronyms/terms and help you better understand what the terms mean in the land of pharmacy and healthcare benefits along with the individual posts! Ready?

A

ACA Preventative Drug List - The Affordable Care Act

Adjudication of claims - or claims processing

ASO - Administrative Services Only or Administrative Services Organization

ASP - Average Sales Price

AWP - Average Wholesale Price

B

Biosimilar

Brand Drug

C

Copay and Coinsurance

Coupon

D

DAW - Dispense as Written

Discount

E

F

Formulary - or Drug Formulary, or Preferred Drug List (PDL)

G

Generic Drug

H I J K L

M

MAC - Maximum Allowable Cost

N O

P

PAPs - Patient Advocacy Programs

PBMs - Pharmacy Benefit Managers

Q

QALY - Quality Adjusted Life Years

?R

?S

Specialty Drugs

T

U

UM - Utilization Management

V W X Y Z

More to come!

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Erin Albert is a pharmacist with Apex Benefits in Indianapolis. This is a series dedicated to breaking down the insider terms on the US healthcare and pharmacy benefit manager (PBM) industries. Opinions on terms and posts are her own, and not necessarily those of her employer.