PBM Terms

Question 1

Pharmacy Contract

Answer 1

An agreement to provide a service in a certain way. Like a cell phone contract, you pay a fee to get service.

Question 2

PBM (Pharmacy Benefit Manager)

Answer 2

A company that explains prescription benefits.

Question 3

Pharmacy Benefit or Drug Coverage

Answer 3

How medications are (or are not) covered, where medications can be filled, and any other rules for payment on a medication.

Question 4

Prescription

Answer 4

A medication order written by a doctor and sent to a pharmacy to be filled.

Question 5

Claim

Answer 5

Medication details submitted electronically by the pharmacy according to the prescription written by your doctor.

Question 6

Client

Answer 6

An employer or company who seeks out Navitus to manage prescription benefits for their employees or members.

Question 7

Member

Answer 7

The member is the person who will actually use the pharmacy benefit to fill prescriptions they receive from their provider.

Question 8

Provider / Prescriber

Answer 8

This is the medical professional (clinician) that prescribes medications for the member.

Question 9

Pharmacy

Answer 9

The pharmacy is the entity that takes the prescription and fills it.

Question 10

TPA (Third Party Administrator) or Health Plan

Answer 10

The company who manages medical coverage.