Health Care Economics 2 Flashcards
most provines have a public plan for what patient groups?
seniors, low income (family), nursing home, high cost meds (cancer, DM, organ transplant, HIV/aids etc.)
what is a premium?
the fee paid at the beginning of joining the program and then annually
is the premium for senior pharmacare income-based?
yes
what is a copayment?
the portion of the Rx cost that you must pay each time you get an Rx up to a yearly max
copayment for family pharmacare is ___%
20
in family pharmacare, ____% is paid by the patient until their deductible is reached
80%
t/f the deductible in family pharmacare is income-based
t
what is MLP?
manufacturer list price
what is MRP?
maximum reimbursement price
what is PRP?
pharmacare reimbursed price (PRP)
what is AAC?
actual acquisition cost (net costs)
what are pharmacist prescribed claims?
- prescribing in an emergency
- renewals
- adaptations
- therapeutic sub
- schedule 2, 3 and unscheduled prescribing
claims for Rx written by PhC that comply with the requirements of the standards are eligible for _____
benefit under the applicable Pharmacare program
are “eligible for benefit” under a program the same as “eligible as an insured service”?
NO!
who negotiates the price, allowable markups & fees for pharmacy services?
department of health and wellness and PANS
price for renewals of 3 or less schedule 1 meds
12$
price for 4 or more schedule 1 meds
$20
price for adaption, refusal to fill, change in dose/duration etc.
14$
price for therapeutic sub for PPIs
26.25$
price for UTI, herpes zoster or contraceptive management?
$20
if a patient has private & public insurance, who is the payer of last resort?
the public plan (always go through the private plan first)
code M means
maximum reimbursement price (MRP)
code P means ___
pharmacare reimbursement price (PRP)
code L means ____
manufacturer list price
the code “C” means
cancer
code “D” means
diabetes
