Lecture 9 (done) Flashcards
How do providers manage drug use?
prior authorization, generic substitution
How do patients manage drug use?
patient cost sharing, utiliization limits
What is a drug formulary?
list of drugs approved for use
what types are formularies are there?
open and closed formularies, tiered formularies
WHat determines formulary placement?
size of manufacturer discounts and rebates, patient cost sharng amounts,
What is prior authorization?
seris of steps to complete before a drug can be dispensed to limit drug use and control costs
What is patient cost sharing?
tiered cost sharing program to promote the use of cheaper medications
Describe copayments.
A typer of cost sharing that is defined as a set payment amount
Describe coinsurance.
patient pays percentage of drug cost
describe a deductable
a set amount that the patient pays before insurance coverage kicks in
What are out of pocket limits?
caps on how much the patient spends in out of pocket costs
what are maximum benefits?
a restriction on how much a service is covered
What are emeging trends in patient cost sharing?
increasing out of pocket costs, seasonal trends in perscription drug spending, value based insurance design
what are Utilization Limits?
used to minimize fraud and medication waste. It is a limit on the number of pills that can be dispensed and how often it can be filled
