Pharmaceutical Pricing And Reimbursement
Expert-defined terms from the Certificate in Pharmacy Benefit Management course at London School of Planning and Management. Free to read, free to share, paired with a professional course.
ABO principles refer to the rules governing the administration of… #
In the context of Pharmaceutical Pricing And Reimbursement, ABO principles can be used to understand how different stakeholders interact and influence the pricing and reimbursement of pharmaceuticals.
Above market pricing refers to the practice of setting pharmaceuti… #
This concept is often discussed in the context of value-based pricing, where the price of a pharmaceutical is tied to its clinical effectiveness and cost-effectiveness.
Absolute contraindications are conditions or characteristics that… #
In the context of Pharmaceutical Pricing And Reimbursement, absolute contraindications can be used to exclude certain patients from receiving reimbursement for a particular pharmaceutical.
Accelerated approval is a regulatory process that allows pharmaceuticals… #
This concept is often discussed in the context of orphan diseases, where there is a limited market for the pharmaceutical and incentives are needed to encourage development.
Accountable care organizations are entities that take responsibility for… #
In the context of Pharmaceutical Pricing And Reimbursement, accountable care organizations can be used to negotiate prices with pharmaceutical manufacturers and manage the use of pharmaceuticals in a cost-effective manner.
ACO models refer to the different approaches used by accountable c… #
In the context of Pharmaceutical Pricing And Reimbursement, ACO models can be used to identify opportunities for cost savings and improve the quality of care.
Active ingredient refers to the component of a pharmaceutical that… #
In the context of Pharmaceutical Pricing And Reimbursement, active ingredients can be used to compare the cost-effectiveness of different pharmaceuticals and negotiate prices with manufacturers.
Adverse event refers to an unwanted or harmful effect of a… #
In the context of Pharmaceutical Pricing And Reimbursement, adverse events can be used to monitor the safety of pharmaceuticals and adjust their pricing and reimbursement accordingly.
Advisory committee refers to a group of experts that provid… #
In the context of Pharmaceutical Pricing And Reimbursement, advisory committees can be used to review the evidence for a pharmaceutical and recommend its approval or rejection.
Aggregate data refers to the collection of data from multip… #
In the context of Pharmaceutical Pricing And Reimbursement, aggregate data can be used to identify trends and patterns in the use of pharmaceuticals and optimize their pricing and reimbursement.
Algorithm based pricing refers to the use of mathematical models t… #
In the context of Pharmaceutical Pricing And Reimbursement, algorithm-based pricing can be used to optimize the pricing of pharmaceuticals and improve their accessibility.
Alternative pricing models refer to approaches to pricing that dif… #
In the context of Pharmaceutical Pricing And Reimbursement, alternative pricing models can be used to improve the affordability of pharmaceuticals and align their price with their value.
Ambulatory care refers to the delivery of medical care in an ou… #
In the context of Pharmaceutical Pricing And Reimbursement, ambulatory care can be used to optimize the use of pharmaceuticals and reduce their cost.
Annual budget refers to the amount of money allocated for a partic… #
In the context of Pharmaceutical Pricing And Reimbursement, annual budgets can be used to plan and manage the cost of pharmaceuticals.
Anti #
kickback statutes refer to laws that prohibit the payment of bribes or kickbacks in exchange for the purchase or recommendation of a pharmaceutical, which can impact the pricing and reimbursement of pharmaceuticals. In the context of Pharmaceutical Pricing And Reimbursement, anti-kickback statutes can be used to prevent corrupt practices and ensure that pharmaceuticals are purchased and recommended based on their merit.
Appeals process refers to the procedure for reviewing and <… #
In the context of Pharmaceutical Pricing And Reimbursement, appeals processes can be used to ensure that patients have access to the pharmaceuticals they need and that disputes are resolved in a fair and timely manner.
Arbitration process refers to the procedure for resolving d… #
In the context of Pharmaceutical Pricing And Reimbursement, arbitration processes can be used to resolve disputes in a fair and efficient manner.
Average wholesale price refers to the average price at which a pha… #
In the context of Pharmaceutical Pricing And Reimbursement, average wholesale prices can be used to compare the prices of different pharmaceuticals and negotiate prices with manufacturers.
Average manufacturer price refers to the average price at which a… #
In the context of Pharmaceutical Pricing And Reimbursement, average manufacturer prices can be used to compare the prices of different pharmaceuticals and negotiate prices with manufacturers.
AWP minus refers to a pricing formula that calculates the price… #
In the context of Pharmaceutical Pricing And Reimbursement, AWP minus can be used to reduce the cost of pharmaceuticals and improve their affordability.
Bundled payment refers to a payment model in which a single pay… #
In the context of Pharmaceutical Pricing And Reimbursement, bundled payments can be used to align the incentives of healthcare providers and payers and improve the quality and efficiency of care.
Capitation payment refers to a payment model in which a fixed p… #
In the context of Pharmaceutical Pricing And Reimbursement, capitation payments can be used to manage the cost of pharmaceuticals and incentivize the efficient use of resources.
Categorical approach refers to a method of classifying phar… #
In the context of Pharmaceutical Pricing And Reimbursement, categorical approaches can be used to compare the prices of different pharmaceuticals and negotiate prices with manufacturers.
Category management refers to the process of managing and <… #
In the context of Pharmaceutical Pricing And Reimbursement, category management can be used to reduce the cost of pharmaceuticals and improve their affordability.
CE mark refers to a certification mark that indicates a pharmaceut… #
In the context of Pharmaceutical Pricing And Reimbursement, CE marks can be used to ensure that pharmaceuticals meet certain standards of quality and safety.
Centers for Medicare and Medicaid Services refers to the agency re… #
In the context of Pharmaceutical Pricing And Reimbursement, the Centers for Medicare and Medicaid Services can be used to set prices and reimbursement rates for pharmaceuticals and manage the use of pharmaceuticals in these programs.
Certificate of need refers to a document that certifies tha… #
In the context of Pharmaceutical Pricing And Reimbursement, certificates of need can be used to justify the use of a pharmaceutical and support its reimbursement.
Chemical entity refers to a substance with a unique chemica… #
In the context of Pharmaceutical Pricing And Reimbursement, chemical entities can be used to compare the prices of different pharmaceuticals and negotiate prices with manufacturers.
Class effect refers to the effect of a pharmaceutical that is s… #
In the context of Pharmaceutical Pricing And Reimbursement, class effects can be used to compare the prices of different pharmaceuticals and negotiate prices with manufacturers.
Clearance process refers to the procedure for reviewing and… #
In the context of Pharmaceutical Pricing And Reimbursement, clearance processes can be used to ensure that pharmaceuticals meet certain standards of quality and safety.
Clinical decision support refers to the use of technology to su… #
In the context of Pharmaceutical Pricing And Reimbursement, clinical decision support can be used to improve the quality and efficiency of care and reduce the cost of pharmaceuticals.
Clinical trials refer to studies that evaluate the safet… #
In the context of Pharmaceutical Pricing And Reimbursement, clinical trials can be used to generate evidence to support the approval and reimbursement of pharmaceuticals.
CMEA compliance refers to the requirement for pharmaceutical ma… #
In the context of Pharmaceutical Pricing And Reimbursement, CMEA compliance can be used to prevent the diversion of pharmaceuticals and ensure that they are used for legitimate medical purposes.
Co #
payment refers to the amount that a patient must pay out-of-pocket for a pharmaceutical, which can impact the accessibility of pharmaceuticals for patients. In the context of Pharmaceutical Pricing And Reimbursement, co-payments can be used to share the cost of pharmaceuticals between patients and payers and incentivize the efficient use of resources.
Co #
insurance refers to the percentage of the cost of a pharmaceutical that a patient must pay out-of-pocket, which can impact the accessibility of pharmaceuticals for patients. In the context of Pharmaceutical Pricing And Reimbursement, co-insurance can be used to share the cost of pharmaceuticals between patients and payers and incentivize the efficient use of resources.
Combination product refers to a pharmaceutical that combines</i… #
In the context of Pharmaceutical Pricing And Reimbursement, combination products can be used to improve the efficacy and safety of pharmaceuticals and reduce the cost of treatment.
Compounding pharmacy refers to a pharmacy that prepares cus… #
In the context of Pharmaceutical Pricing And Reimbursement, compounding pharmacies can be used to provide patients with access to customized pharmaceuticals that are not available through traditional channels.
Comprehensive care refers to the delivery of coordinated an… #
In the context of Pharmaceutical Pricing And Reimbursement, comprehensive care can be used to improve the quality and efficiency of care and reduce the cost of pharmaceuticals.
Concurrent review refers to the process of reviewing and <i… #
In the context of Pharmaceutical Pricing And Reimbursement, concurrent review can be used to ensure that pharmaceuticals are used appropriately and efficiently.
Condition specific refers to a pharmaceutical that is indicated… #
In the context of Pharmaceutical Pricing And Reimbursement, condition-specific pharmaceuticals can be used to target specific populations and improve the efficacy and safety of treatment.
Contract negotiation refers to the process of negotiating t… #
In the context of Pharmaceutical Pricing And Reimbursement, contract negotiation can be used to secure favorable prices and terms for pharmaceuticals.
Controlled substance refers to a pharmaceutical that is regulat… #
In the context of Pharmaceutical Pricing And Reimbursement, controlled substances can be used to prevent the diversion of pharmaceuticals and ensure that they are used for legitimate medical purposes.
Copayment wavier refers to the waiver of a patient's co #
payment for a pharmaceutical, which can impact the accessibility of pharmaceuticals for patients. In the context of Pharmaceutical Pricing And Reimbursement, copayment waivers can be used to improve the affordability of pharmaceuticals and increase patient adherence to treatment.
Cost #
effectiveness analysis refers to the evaluation of the cost and effectiveness of a pharmaceutical, which can impact the pricing and reimbursement of pharmaceuticals. In the context of Pharmaceutical Pricing And Reimbursement, cost-effectiveness analyses can be used to compare the value of different pharmaceuticals and inform pricing and reimbursement decisions.
Cost #
sharing refers to the practice of sharing the cost of a pharmaceutical between a patient and a payer, which can impact the accessibility of pharmaceuticals for patients. In the context of Pharmaceutical Pricing And Reimbursement, cost-sharing can be used to incentivize the efficient use of resources and improve the affordability of pharmaceuticals.
Cost #
utility analysis refers to the evaluation of the cost and utility of a pharmaceutical, which can impact the pricing and reimbursement of pharmaceuticals. In the context of Pharmaceutical Pricing And Reimbursement, cost-utility analyses can be used to compare the value of different pharmaceuticals and inform pricing and reimbursement decisions.
Coverage determination refers to the process of determining … #
In the context of Pharmaceutical Pricing And Reimbursement, coverage determinations can be used to ensure that patients have access to the pharmaceuticals they need and that coverage is consistent with the terms of the benefit plan.
Coverage gap refers to a period of time during which a patient is… #
In the context of Pharmaceutical Pricing And Reimbursement, coverage gaps can be used to identify opportunities to improve the affordability of pharmaceuticals and increase patient adherence to treatment.
Current procedural terminology refers to a system of codes … #
In the context of Pharmaceutical Pricing And Reimbursement, current procedural terminology can be used to standardize the description of services and facilitate the communication between healthcare providers and payers.
Data analytics refers to the process of analyzing data</… #
In the context of Pharmaceutical Pricing And Reimbursement, data analytics can be used to identify trends and patterns in the use of pharmaceuticals and optimize their pricing and reimbursement.
Decision support refers to the use of technology to support … #
In the context of Pharmaceutical Pricing And Reimbursement, decision support can be used to improve the quality and efficiency of care and reduce the cost of pharmaceuticals.
Deductible amount refers to the amount that a patient must pay<… #
In the context of Pharmaceutical Pricing And Reimbursement, deductible amounts can be used to incentivize the efficient use of resources and improve the affordability of pharmaceuticals.
Disease management refers to the process of managing and <i… #
In the context of Pharmaceutical Pricing And Reimbursement, disease management can be used to improve the quality and efficiency of care and reduce the cost of pharmaceuticals.
Dispensing fee refers to the amount paid to a pharmacy for… #
In the context of Pharmaceutical Pricing And Reimbursement, dispensing fees can be used to compensate pharmacies for their services and incentivize the efficient use of resources.
Distribution channel refers to the path that a pharmaceutical take… #
In the context of Pharmaceutical Pricing And Reimbursement, distribution channels can be used to ensure that pharmaceuticals are delivered to patients in a safe and efficient manner.
Dose escalation refers to the process of increasing the … #
In the context of Pharmaceutical Pricing And Reimbursement, dose escalation can be used to optimize the use of pharmaceuticals and reduce the cost of treatment.
Drug utilization review refers to the process of reviewing … #
In the context of Pharmaceutical Pricing And Reimbursement, drug utilization reviews can be used to ensure that pharmaceuticals are used appropriately and efficiently.
Electronic health record refers to a digital version of a patient'… #
In the context of Pharmaceutical Pricing And Reimbursement, electronic health records can be used to improve the quality and efficiency of care and reduce the cost of pharmaceuticals.
Electronic prescribing refers to the process of prescribing … #
In the context of Pharmaceutical Pricing And Reimbursement, electronic prescribing can be used to improve the accuracy and efficiency of the prescribing process and reduce the cost of pharmaceuticals.
Ex factory price refers to the price of a pharmaceutical at the <b… #
In the context of Pharmaceutical Pricing And Reimbursement, ex factory prices can be used to compare the prices of different pharmaceuticals and negotiate prices with manufacturers.
Ex works price refers to the price of a pharmaceutical at the p… #
In the context of Pharmaceutical Pricing And Reimbursement, ex works prices can be used to compare the prices of different pharmaceuticals and negotiate prices with manufacturers.