Terms
When referring to sensitive circumstances like economic loss or global pandemics, avoid describing their impact/effects as being "hard hitting" or "hit hard."
Per the AP Stylebook, use the % sign in copy when paired with a numeral, with no space, in most cases. For example: CoverMyMeds’ ePA product integrates with 75% of EHRs. However, if it’s necessary to start a sentence with a percentage, spell out both. For example: Seventy-five percent of EHRs integrate with CoverMyMeds’ ePA product.
The 340B Drug Pricing Program resulted from the enactment of Public Law 102-585, the Veterans Health Care Act of 1992, which is codified as Section 340B of the Public Health Service Act. Section 340B limits the cost of drugs to Federal purchasers and to certain grantees of Federal agencies
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A super quick tip on “a lot” Here’s something we probably all see a lot — a lot is ALWAYS “a lot” — “alot” is NOT a word. Just think, there’s A LOT of space in the phrase “a lot.” See more tips and tricks like this in our Writer term bank!
“A part” vs. “apart” We’ve seen this a time or two. “A part” and “apart” sound similar, but they have totally different meanings. - A part (two words) means “a fraction of a whole,” or “an actor’s role.” - Apart (one word) denotes a separation between two or more things. For example: “I’d really love to be a part of this work project and stretch my skills” is CORRECT! “I hate to be apart from my coworkers; they are my favorite
Network of providers collectively accountable for the total cost and quality of care for a population of patients; ACO’s are reimbursed through total cost payment structures, such as the shared savings model or capitation.
Pharmacy purchase price for a drug in accordance with the pharmacy’s contract with the wholesale distributors.
The AP Stylebook recommends only using widely recognized acronyms, such as NASA, FBI and DNA. If the acronym is not well-known, spell it out on first use. Since we write content for the healthcare industry, we do NOT need to spell out EHR (electronic health record) on first use. However, always spell out prior authorization (PA) and electronic prior authorization (ePA) on first use.
Pharmacy claims processing, which is conducted by third-party payers. According to NextGen Healthcare, payer or claims adjudication “is when a third-party payer receives your medical claim and starts the review process. The payer decides, based on the information you provide, whether the medical claim is valid and should be paid.” Notably, some ePA requests can be adjudicated algorithmically, especially for simple, low-cost medications. However, ePA requests for complex, high-cost medications often require clinician review or peer-to-peer discussion.
Another set of pesky homophones! Affect is usually a verb, and it means “to impact or change.” Effect is usually a noun, and it means “the result of a change.” Here’s a helpful hint: If you can substitute affect with another verb, you are using the right word. For example: "The music affected him” --> “The music moved him” A couple more examples for good measure: “The flood will likely affect this year’s crops significantly” is CORRECT! “The flood’s effect on this year’s crops will be devastating” is CORRECT!
Officially called the Patient Protection and Affordable Care Act (PPACA) or colloquially called “Obamacare," as a United States federal statute signed into law on March 23, 2010. Key provisions are intended to extend coverage to millions of uninsured Americans, to implement measures that will lower health care costs, and improve system efficiency, and to eliminate industry practices that include rescission and denial of coverage due to pre-existing conditions.
“Alt text” means “alternative text.” It's a short description of an image, and it’s important to a website's accessibility — not to mention its search engine optimization (SEO) strategy. A few facts about alt text: - Read by screen readers; allows people who are blind to access content - Displays in place of images in browsers if image files haven’t loaded yet - Describes images, making your page more “rankable” by search engines
A pharmacy where a pharmacist provides direct patient care for a specific disease state or group of diseases.
A member-owned cooperative of over 2,000 independent pharmacies. AAP has both buying group and pharmacy-service administrative organization (PSAO, payer contracting) divisions.
A member-owned buying group established to protect and promote the interest of member pharmacies.
A professional organization representing the interests of pharmacists who practice in hospitals, HMOs, long-term care facilities, home care, and other components of health care. Previously known as the American Society of Hospital Pharmacists.
Mckesson Distribution’s second-largest drug wholesaler competitor. PSAO and associated pharmacy franchise division is Good Neighbor Pharmacy.
The full proper name of our patient support solution. Subsequent use: AMP.
A set of laws that require managed care organizations to grant network participations to all pharmacies willing to join and meet network quality requirements.
Apostrophes for possessives We follow AP Style at CoverMyMeds. Here’s how the AP approaches apostrophes for possessives: Singular common nouns ending in “s” — add ‘s - The virus’s reach Singular proper names ending in “s” — use only ‘ - Dickens’ novels If ownership of something is shared, use 's after the second owner. - Example: David and Karen’s cat If the ownership of something is separate, use ‘s after each owner. - Example: David’s and Karen’s cats
While it's a more formal version of "correct" or "right," we use "appropriate" when describing physician decision-making on behalf of their patients.
Use "about" instead - it's simpler and more concise
About is often used interchangeably with approximately, but it doesn't stress the closeness to accuracy that approximately does. For example: “There are about 12 million people living in Ohio” is correct. “There are approximately 11.69 million living in Ohio” is correct. When you are using numbers, it’s appropriate to use the tilde (~) before the number to refer to an estimate, e.g., ~12 million people live in Ohio.
A specialty pharmacy summit held in Las Vegas. CoverMyMeds goes every year.
Assure vs. Insure vs. Ensure All three verbs have something to do with “making sure” and are therefore similar, but they have different and distinct meanings: - To assure someone is to remove their doubts or misgivings. - To insure something is to cover it with an insurance policy. - To ensure something is to make sure or guarantee it happens. Let’s see them ALL used in one sentence: “The vase is insured, so I assure you — if it breaks, we’re ensured a full refund.”
RelayHealth saves daily dose on first claim submission to data files and rejects subsequent claims when saved dose doesn't match resubmitted daily dose and messages the pharmacy for verification. After verification, pharmacy resubmits the claim with the appropriate quantity.
A quarterly, calculated average dictated by the Centers for Medicare and Medicaid Services of what wholesalers pay drug makers. AMP is also the basis of prescription drug payments to pharmacies under Medicaid.
Set by Medispan and First Data Bank, this pricing information is "based on data obtained from manufacturers, distributors, and other suppliers." Whatever method such information was obtained, it turns out that published AWPs are grossly inflated relative to actual market prices for drugs. AWP has been used to determine third-party reimbursement throughout the health care industry because third-party payers have no other reliable method of obtaining real market prices (most contracts contain confidentiality clauses). Reimbursement amounts are typically based on AWP minus some percentage.
The negotiated price that an insurer will pay for each prescription (example: AWP – 8%). AWP = Average Wholesale Price.
Series of (6) digits that identify third-party payers for the purpose of payer identification, and in the case of pharmacy claims network processing, correct claims routing. Note: RelayHealth also uses internal “BINS” to implement pharmacies under the appropriate value-added programs.
In general, use “between” when referring to one-to-one relationships and use “among” when referring to indistinct, nonspecific or imprecise relationships. For example, -- “They had to choose between two Airbnb properties for their family vacation” is correct. -- “They had to choose among all the options on Airbnb for their family vacation” is correct. To make things confusing, though, you can also use “between” when referring to MULTIPLE one-to-one relationships — if they’re separate and distinct. For example, -- “They chose between three properties — one with an ocean view, one with a mountain view and one with a lake view” is correct.
Blizzard Season, or PA Season, is the period from January to March when prior authorization volume peaks (about 30% of all PA volume comes in this month). DON'T use this term in external use.
Carries the name given to it by the original manufacturer, who retains the exclusive right to sell the drug for a certain period. When the patent protection for a brand-name drug expires, the formula of the drug must be released and other manufacturers are free to develop a version of it known as a generic drug.
In their day-to-day role, these individuals manage the brand franchise under a pharmaceutical manufacturer setting marketing initiatives and priorities based on the company’s priorities. This includes: - Ensuring that quantitative and qualitative objectives are met - Driving strategic development of the brand portfolio - Identifying new products and packaging - Developing and implementing consumer promotions - Planning and monitoring marketing budgets
Pharma companies love discussing “breadth and depth” as it relates to their knowledge resources, therapeutic areas, product lifecycles, provider reach, etc. In simple terms, breadth refers to the full span of knowledge/experience/portfolios, whereas depth refers to the extent of specific knowledge/experience/portfolios. Typically, pharma companies strive for both breadth and depth in their operations.
A written arrangement that specifies each party’s responsibilities when it comes to PHI (Protected Health Information). The satisfactory assurances must be in writing, whether in the form of a contract or other agreement between the covered entity and the business associate.
Group purchasing organizations that collectively increase community pharmacy drug purchasing power for member pharmacies.
McKesson Distribution’s second-largest wholesaler competitor. PSAO (Pharmacy Services Administrative Organization) division is a profit leader and the associated pharmacy franchise is Medicine Shoppe.
By definition, you can’t center around something; rather, you center on something and revolve around something. Think of a bullseye — you center on a bullseye, not around it. For example: - “My daughter’s history paper is centered on Ruth Bader Ginsburg’s life and legacy” is right BUT... - “My daughter’s history paper is centered around Ruth Bader Ginsburg’s life and legacy” is wrong.
Federal agency within the US Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program, and health insurance portability standards.
One large pharmacy that packages medications and delivers them to smaller pharmacies for distribution to patients.
A group of pharmacies owned by a corporate entity under the same name.
McKesson defines "chain pharmacy" as a group of pharmacies under common ownership with over 15 sites.
New health care entity formed by former Emdeon and McKesson’s former RelayHealth Clinical division. Handles medical claims billing and clinical solutions in the hospital/health system market.
The financial offsets that manufacturers apply to the Wholesale Acquisition Cost to reduce the cost of goods to the contract price negotiated between the customer and the manufactures.
Check in (two words) is a verb; check-in (hyphen) is an adjective or noun. Checkin (one word) is WRONG! For example: “You need to check in to your flight before departure.” “My airline requires early check-in for extra luggage.”
Use the verb “choose” when (1) encouraging patients to make a decision that is more subjective, strategic, emotional, or open-ended; (2) patients have to pick from a large inventory of items, like themes, or options that require strategic decision making, like pricing plans
Our preferred format for citations is: “Article Name/Web Page, Publication Name, Date.” For example: "Meet the Winners of 2021’s Annual CoverMyQuest Mini Grant Contest, CoverMyMeds, Oct. 24, 2021." If applicable, hyperlink the entire citation to its URL.
National Council for Prescription Drug Programs (NCPDP) standard pharmacy claim which is used to adjudicate and bill prescriptions.
ClinicalAlertsPlus (TM) automatically identifies opportunities to counsel and engage patients for additional clinical services — such as vaccinations — within the pharmacist's workflow by leveraging prescription history data. Designed for participating pharmacies and for eligible patients, CA+ helps integrate the pharmacist into the patient's health care team. Patient eligibility is based on pre-defined criteria such as: age and location, coverage and copay range.
Term used to describe any pharmacies that are located within a hospital; typically do not offer outpatient services.
A formal agreement in which a licensed provider makes a diagnosis, supervises patient care, and refers patients to a pharmacist under a protocol that allows the pharmacist to perform specific patient care functions (ex. flu shots, dose alterations, etc.)
Commercial health insurance is a type of health insurance that covers medical expenses and disability income for the insured (non-government).
A healthcare facility that provides pharmacy services to people in a local area or community. (RelayHealth defines community pharmacy as pharmacies with 1-25 sites).
(Also pharmaceutical compounding and compounding pharmacy) is the mixing of drugs by a compounding pharmacist to fit the unique needs of a patient. This may be done for medically necessary reasons, such as to change the form of the medication from a solid pill to a liquid, to avoid a non-essential ingredient that the patient is allergic to, or to obtain the exact dose needed. It may also be done for voluntary reasons, such as adding favorite flavors to a medication.
Continuity of Care streamlines prior authorization (PA) process requirements which can slow down a pharmacist's workflow and lead to prescription abandonment. This valuable pharmacist solution dispenses prescribed medication immediately, without additional actions needed to process a prior authorization. By eliminating the delay in therapy caused by waiting for a manual prior authorization process, Continuity of Care helps pharmacists work more efficiently. For qualified prescriptions, Continuity of Care converts a rejected claim into a paid claim while simultaneously submitting a prior authorization request to the prescriber in real time. Pharmacists can dispense a prescription drug while the prescriber and third party review the prior authorization, thus allowing patients to access to their medications right away.
Software development term. CI/CD bridges the gaps between development and operation activities and teams by enforcing automation in building, testing and deployment of applications. Modern day DevOps practices involve continuous development, continuous testing, continuous integration, continuous deployment and continuous monitoring of software applications throughout its development life cycle. The CI/CD practice or CI/CD pipeline forms the backbone of modern-day DevOps operations. RHP employs CIDC to improve the efficiencies associated with the development, QA, testing, and deployment of solutions. CIDC automates traditionally manual, human processes to decrease time to market.
Contractions are typically preferable for common phrases — they help our brand voice sound approachable and less stuffy. For example: do not = don’t, is not = isn’t, should not = shouldn’t, was not = wasn’t, you are = you’re, it is = it’s. And so on or and so forth.
Schedule 2-5 drugs are considered controlled substances. In the United States, the Drug Enforcement Administration is responsible for suppressing illegal drug use and distribution by enforcing the Controlled Substances Act, which regulates both the drugs themselves and certain precursors. Some U.S. states have additional restrictions for substances which might or might not be regulated by the federal government. The five classes of drugs are narcotics, depressants, stimulants, hallucinogens, and anabolic steroids.
When in doubt, keep things simple. Copay versus co-pay. Email versus e-mail. Biopharma versus bio-pharma. Preexisting versus pre-existing. Copay, email, biopharma and preexisting are all correct — no hyphen needed.
Counsel vs. council Counsel is the word for advice, or the act of giving advice. Council is the word for an advisory group or meeting. For example — providers counsel patients; they also sit on advisory councils. Here’s a trick to remember: “Counsel” has an “e,” which relates to empathy and emotion. “Council” has an “i,” which relates to individuals and insight.
According to Merriam-Webster and general usage, "covered" means that a medical treatment or evaluation is paid for by insurance, in full or in part depending on the payer plan. This term can apply to a person or to a medical treatment or evaluation. See also: uncovered
The name of a companywide volunteer initiative that runs in August.
The term coronavirus is generally acceptable in references to the pandemic: Coronavirus cases, coronavirus tests, coronavirus variants. Use the term COVID-19 when referring specifically to the disease: COVID-19 treatments, COVID-19 patients, COVID-19 deaths. Legal is particular about making sure we say “COVID-19 pandemic” when referring to the pandemic and just “COVID-19” when talking about the virus.
Use tailored instead
Abbreviate Jan., Feb., Aug., Sept., Oct., Nov. and Dec. when writing a date, but spell the month when pairing with a year, such as “January 2022.” Also, don’t use "on" before a date or day of the week when its absence would not lead to confusion. For example, “My best friend was born Jan. 26, 1990” and “The meeting will be held Wednesday” are both CORRECT.
A DEA number is assigned by the Drug Enforcement Administration to many types of healthcare providers, including physicians, optometrists, dentists, veterinarians, physician assistants and nurse practitioners. The DEA number allows providers to write prescriptions for controlled substances; it is also a way for the DEA to track provider prescriptions and monitor potential fraud and abuse.
The transfer of a specific act, task or function, by a licensee who holds a license other than a health profession subfield license, to a licensed or unlicensed individual who is otherwise qualified by education, training or experience to perform the act, task or function (example: a physician delegates the act of administering a flu shot to a pharmacist under a collaborative practice agreement).
RelayHealth's Denial Conversion solution increases patient adherence to pharmaceutical brand medications with copay savings on rejected prescription claims. If a claim is rejected as non-reimbursable for a qualified National Drug Code (NDC), Denial Conversion converts the rejected claim into a paid response and returns the specific patient copay and patient savings notification. The prescription drug is then dispensed as prescribed, thus helping to improve medication adherence.
generic version of Durezol
A terminology that commercial plans/PBMs are now using to categorize certain pharmacy network participation fees and the reconciliation of certain contractual terms with actual reimbursement. CMS didn’t foresee that “DIR fees” would be used to describe these types of fees charges by plans/PBMs under this moniker. DIR fees are not captured/calculated during the adjudication process, but rather these “true-ups” can occur months after a claim has been adjudicated and paid, posing a huge challenge to pharmacies regarding claims reconciliation and profitability. Pharmacy performance metrics used to determine these “claw-backs” or potential pharmacy bonus payments, vary from plan to plan/payer to payer. These metrics may include generic dispense rates, preferred product rates, refill rates and others comparing pharmacies against others using designated performance factors. Pharmacy performance measures may be applies by-store or in aggregate across pharmacy groups.
NCPDP code required by third-party payers which represents dispensing conditions. There are (9) DAW codes with 0,1,2 being the most frequently used: - DAW (0): unspecified - DAW (1): brand medically necessary. Generic substitution not allowed - DAW (2): patient requested brand. Used when a generic is available, but the patient insists on brand. NOTE: Using the incorrect DAW code when dispensing prescriptions may result in severe reimbursement loss to the pharmacy. This is called a “MAC loss.”
The fee paid for prescriptions filled. Although the fee could potentially be equal for all prescriptions, habitually the dispensing fee paid to the pharmacy is elevated for generics and thus incents the pharmacy to help generic substitutions.
An identifier assigned to a health care provider (such as a pharmacist, physician, optometrist, dentist) by the United States Drug Enforcement Administration allowing them to write prescriptions for controlled substances.
How Novartis sometimes refers to the brand-direct program when speaking about it
Process Medicare Part B claims. Examples include Omnisys and Allwin to which RelayHealth connects pharmacies (SEE MEDICARE PART B)
Brand-name drug from Novartis that's used in ScriptHero's brand-direct program
Each vs. every is a tricky grammar issue, even for pro writers. Typically, each refers to TWO or more objects/people and every refers to THREE or more objects/people. For example: “I have a mosquito bite on each foot” is CORRECT. “I have a mosquito bite on every toe” is CORRECT.
Electronic Health Record. OK to not spell this out in first instance.
Avoid this description when talking about patients
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed and consulted by authorized clinicians and staff across MORE THAN ONE healthcare organization.
An electronic record of health-related information on an individual that can be created, gathered, managed and consulted by authorized clinicians and staff within ONE healthcare organization.
Use an em dash (—) versus an en dash (–) to offset an aside. An en dash (–) is almost never used at CoverMyMeds. To mark ranges, such as “The plumber will arrive between 1-3 p.m.” or “The 2020-2021 fiscal year performance was strong,” use a hyphen (-). Pro-tip: An em dash is roughly the width of the letter M/m (when typesetting), and an en dash is about the width of the letter N/n. Pro-tip 2: On a Mac, use the keyboard shortcut option-shift-hyphen to quickly create an em dash.
When in doubt, keep things simple. Copay versus co-pay. Email versus e-mail. Biopharma versus bio-pharma. Preexisting versus pre-existing. Copay, email, biopharma and preexisting are all correct — no hyphen needed.
McKesson-owned; Hosted Pharmacy Management System; SaaS pharmacy software that manages pharmacy operations, prescription drug dispensing and patient wellness programs in one centralized application. What the ScriptHero pharmacy uses.
electronic Prior Authorization (ePA) is the electronic transmission of information between the prescriber and payer to determine whether a prior authorization (PA) request is granted. SPELL out electronic Prior Authorization (ePA) on first use. Subsequent uses can use the abbreviation ePA.
ePrescribe or electronic prescribing is a technology framework that allows physicians and other medical practitioners to write and send prescriptions to a participating pharmacy electronically instead of using handwritten or faxed notes or calling in prescriptions.
McKesson’s RelayHealth division's largest pharmacy network competitor (formerly referred to as Emdeon).
This is the other upper limit complementing the FUL (Federal Upper Limit). EAC is the state’s estimated price paid by providers for a drug. It is often used for single-source (i.e., “brand”) drugs. Most states use AWP (Average Wholesale Price) to calculate EAC.
We use ET not EST (or EDT) to refer to our hours
Every day vs. Everyday Contrary to popular belief, “every day” and “everyday” are NOT interchangeable! Everyday is an adjective that means “ordinary” or “typical.” Every day is a phrase that simply means “each day.” For example: “Going to the gym is part of my everyday routine” is CORRECT! “I go to the gym every day to run on the treadmill” is CORRECT! Another example: “These are my everyday clothes; they aren’t special” is CORRECT! “I wish I could wear these special clothes every day” is CORRECT!
Provides real-time monitoring of claims so that a pharmacist may avoid adjudicating government prescription plan claims for prescriptions written by excluded prescribers.
IN certain scenarios, we can use faster but legal when we have a qualifier (ex: "faster than traditional phone and fax methods")
Do not use words that identify us as a potential "monopoly."
In 1987, regulations limited the amount which Medicaid could reimburse for drugs with available generic drugs under the Federal Upper Limit (FUL) Program. These limits are intended to assure that the Federal government acts as a prudent buyer of drugs. The concept of the upper limits program is to achieve savings by taking advantage of the current market prices. A calculation performed by the Centers for Medicare and Medicaid Services (CMS) that multiplies a product’s AMP (average manufacturer's price) by 175 percent, which is the maximum that a pharmacy is allowed to charge for the product.
Agreements formalized in contracts between manufacturers and wholesale distributors and compensate wholesale distributors for numerous services, including drug distribution, keeping inventories within target ranges, meeting service-level targets to wholesale customers, managing receivables risk, maintaining stable ordering patterns, providing accurate forecasts of future purchases, and submitting timely and accurate data to manufacturers, among other things.
While also a general term, in the healthcare industry, financial assistance and patient assistance refer to channels that brands use to provide support to patients who can’t afford their medications. Patient or financial assistance programs require patients to apply and meet income requirements to be eligible.
The rule that limits a pharmacy from selling more than 5% of either its total annual sales or total dosages in a 12-month period as “For Office Use.”
Follow up (two words) is a verb Follow-up (hyphen) is a noun Followup (one word) is WRONG For example: “I’ll follow up with you later today to check on your progress” is CORRECT “Let's schedule a quick follow-up to check on your progress” is CORRECT
An agency within the U.S. Public Health Service, which is a part of the Department of Health and Human Services. −The FDA regulates over $1 trillion worth of products, which account for 25 cents of every dollar spent annually by American consumers and touches the lives of virtually every American every day. It is FDA's job to see that food is safe and wholesome, cosmetics won't hurt people, that medicines and medical devices are safe and don’t hurt people, the medicines and medical devices are safe and effective, and that radiation-emitting products such as microwave ovens won't do harm. Feed and drugs for pets and farm animals also come under FDA scrutiny. FDA ensures that all of these products are labeled truthfully with the information that people need to use them properly.
A non-controlled medication that is sold by a pharmacy to a practitioner for in-office use.
A formulary is a list of prescription drugs that are covered under a health insurance plan.
Don't say that our prior authorization solution is "free" for providers to use -- instead, rephrase the sentence to use "no cost."
Generic code number ("GCN") was created by First Data Bank to uniquely identify a combination of ingredient, strength, form, and route. The GCN is a 5-digit number, assigned sequentially.
Has the same active ingredients as the original brand, but it may use different inactive ingredients, such as fillers, that may affect the color or shape of the drug. Generic drugs are also likely to differ from original brand name drug with respect to configuration, release mechanisms, packaging shape, and scoring. In other respects, the drug is clinically identical. Generic drugs usually cost 30 to 60 percent less than the corresponding brand name drugs, and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. NOTE: Pharmacies typically dispense generics 75-80% of the time as they typically cost less to acquire.
These drugs are defined by the Centers for Medicare and Medicaid Services (CMS) as products with three or more versions of the product related therapeutically equal (A-rated) no matter what the ratings of other versions (B-rated) and at least three suppliers are listed in the current editions of published national compendia.
These include brand-name drugs that are going of patent and a single manufacturer has exclusive rights to make the drug for a period of time.
This indicates whether this product is available from more than one source. The following numbers correspond to the definitions below: 0 is unspecified; 1 is multi-source; 2 is single-source.
A 14-character hierarchical classification system that identifies drugs from their primary therapeutic use down to the unique interchangeable product regardless of manufacturer or package size. The code consists of seven subsets, each providing increasingly more specific information about a drug available with a prescription in the United States. The first six characters of the GPI define the therapeutic class code, the next two pairs the drug name, and the last four define route, dosage or strength.
Capitalize always unless it's part of a file name (e.g., Patient.gif)
The total amount of requested reimbursement by the pharmacy (ingredient cost + a dispensing fee).
An entity that leverages the purchasing power of health system pharmacies to obtain discounts from vendors. May also be used interchangeably with the term “buying group," which are drug purchasing groups in the world of independent pharmacy. Buying groups leverage their collective buying power to reduce drug purchasing costs for member pharmacies.
Remember — when talking about our industry, it’s healthcare (one word), not health care (two words).
HIPAA was passed by Congress in 1996. HIPAA does the following: - Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs - Reduces health care fraud and abuse - Mandates industry-wide standards for health care information on electronic billing and other processes; and - Requires the protection and confidential handling of protected health information. The HIPAA Privacy regulations require health care providers and organizations, as well as their business associates, to develop and follow procedures that ensure the confidentiality and security of protected health information (PHI) when it is transferred, received, handled, or shared. This applies to all forms of PHI, including paper, oral, and electronic, etc. Furthermore, only the minimum health information necessary to conduct business is to be used or shared.
We prefer this phrase l/c and with a hyphen
Per AP Style, “homepage” is one word, not two.
Capitalize always unless it's part of a file name (e.g., Patient.html)
The primary mission of a hub services provider is to ensure patients get access to lifesaving therapies by simplifying the process and reducing out-of-pocket expenses. The term “hub” describes how these service providers act as core in the process connecting the patient, prescriber, manufacturer, specialty pharmacy, and insurer. Their role is crucial to making this process viable and is considered a best practice for coordinating a well-rounded care protocol.
A CoverMyMeds pharma solution; spell out in all instances.
A note on hyphens: Use a hyphen (-) to join two or more words to form a compound adjective that describes a noun. If the two adjectives alone wouldn’t properly describe the noun, they need a hyphen. For example: “I’m a self-motivated person.” - Since “I’m a self person” doesn’t really make sense, self and motivated need to be hyphenated. “I love chocolate-covered raisins.” - Since “I love covered raisins” doesn’t really make sense, chocolate and covered need to be hyphenated. +++ Adverbs ending in -ly don't need a hyphen to connect with the word that follows. It's already acting as a modifier in essence. For example: "Lightly edited sentence" is correct but "lightly-edited sentence" is not. "Slightly correct grammar" is right but "slightly-correct grammar" is not.
i.e. is short for id est, which means "in other words." I.e. is used to restate or reword something previously said to clarify its meaning. e.g. is short for exempli gratia, which means "for example." e.g. is used to provide an example or example(s) for the previous statement. For example: “To bring down a fever (i.e. 100.4 degrees) take an OTC medication.” “To bring down a fever, try taking an OTC medication (e.g. Tylenol or Advil).”
Brand-name drug from Novartis that's used in ScriptHero's brand-direct program
In person (two words) is an adverb; in-person (hyphen) is an adjective. Most commonly, in person describes a verb, such as “to go” or “to talk” whereas in-person describes a noun, such as “interview” or “appointment.” For example: “I’m going to the doctor in person to get my test results” is correct. “I have an in-person appointment to get my test results” is correct.
A community (retail) pharmacy that is not directly affiliated with a chain of pharmacies and is not owned by a publicly traded company. (Used interchangeably with Community Pharmacy). RelayHealth defines community pharmacy, as pharmacies with between 1-25 pharmacy sites.
A trade group and retail pharmacy buying cooperative representing over 2,700 pharmacies on the East Coast.
The nation’s largest Group Purchasing Organization (GPO) for independent pharmacies, representing over 4,500 pharmacy members.
This McKesson segment contains several pharmacy types: stand-alone independent drug stores, stores with in-store pharmacies, small chain drugstores, and other merchants that lack the ability to independently warehouse their own pharmaceuticals.
McKesson defines an independent, or community pharmacy, as a pharmacy under single ownership with 1-15 sites.
NCPDP claim field that is used to submit pharmacy pricing. Typically, pharmacies will submit the AWP in this field.
A network of health care organizations under a parent holding company. Some have an HMO component, while others are a network of physicians only, or of physicians and hospitals. The term is used broadly to define an organization that provide a continuum of health care services.
Our automated ePA solution for pharmacies. Subsequent use: IPA.
Unless it starts a sentence, always use the lower case version.
“Into” (one word) is a preposition* that indicates movement, action or transformation. “In” and “to” are two unrelated words — the adverb “in” and the preposition “to” — that sometimes wind up next to each other by accident. *A preposition is a positioning word that shows a relationship, usually in terms of space or time, between words in a clause or phrase. A couple examples for you: - “Please put the cat into his carrier” is CORRECT! - “The cat came in to eat his dinner” is CORRECT! Helpful hint: If you can replace “in” and “to” with “in order to,” use “in to,” NOT “into."
ITS VS. IT'S This common mistake happens to the best of us! - Its is possessive - It’s means “it is” Alas, it can be confusing since ‘s typically makes a word possessive. But remember, if you can’t logically replace “it’s” with “it is” in a sentence, then it’s its.
How to write job titles BEFORE and AFTER names: When a title comes before the name, the title is capitalized. When a title comes after the name, the title is lowercase. For example: “CoverMyMeds President Nathan Mott will attend the conference in May” is correct. “Nathan Mott, CoverMyMeds president, will attend the conference in May” is correct.
Capitalize always unless it's part of a file name (e.g., Patient.jpeg)
It's spelled “judgment,” NOT “judgement.” Although both are technically correct, AP Stylebook prefers the shorter version — no extra “e."
Would you say... “the last two years” or “the past two years”? Is it last two years or past two years? In general, use “last” when talking about a period of time/event that’s over. Use “past” when talking about a period of time/event that’s ongoing. For example: “I’ve worked on this project the last two years” implies the project is over. BUT “I’ve worked on this project the past two years” implies the project is ongoing.
Leading Industry vs. Industry-Leading When referring to CoverMyMeds’ network, our legal team prefers we say it’s “leading industry” instead of “industry-leading.” For example: “CoverMyMeds Specialty Pharmacy Solutions: A portfolio of specialty pharmacy technology solutions, backed by a leading industry network designed to benefit healthcare stakeholders.”
Less vs. Fewer In general, use “fewer” when the number/quantity is counted, such as “eggs.” Conversely, use “less” when the number/quantity is measured, such as “time.” For example: - “I have fewer eggs than I thought; I need to go to Kroger later to buy more” is correct! - “I have less time than I thought; I need to hurry up and take a shower soon” is correct! That said, it’s very common for people to colloquially say/write things like “it’s less than three miles,” or “it’s less than ten dollars.” For those instances, let your instincts guide you.
Per AP style, "life cycle" is TWO words, not one. When talking about a pharma brand's life cycle, use TWO words, not one.
Log in (two words) is a verb and login (one word) is either a noun or adjective. Log-in is NOT correct. Examples: - “You need to log in to your account to access the CoverMyMeds portal” - “My CoverMyMeds login isn't working, do I need to change my password?”
Long-term care pharmacies serve the residents of nursing homes, assisted-care facilities, extended-care facilities, and/or retirement homes. Usually these are “closed-door” pharmacies, meaning that someone cannot walk in and get a prescription filled like they could at a community retail pharmacy.
Lose is a verb that means “to fail to win, to misplace, or to free oneself.” Loose is an adjective that means “not tight.” For example: “Whether you win or lose, playing tennis is great exercise” is CORRECT! “I lost my tennis match because my shoes were too loose” is CORRECT! Here’s a visual trick to help you remember: “loose” is long with its extra “o,” so “loose” would be a longer, looser rope than “lose.”
A type of pharmacy service that will deliver a patient’s medication to their home.
We should always avoid referring to biopharma companies as "manufacturers" — that term does not resonate with their mission of discovering and developing life-saving therapies. They prefer to be referred to/thought of as "innovators."
List refers to a payer or PBM-generated list of products that includes the upper limit or maximum amount that a plan will pay for generic drugs and brand name drugs that have generic versions available (“multi-source brands”).
May and might may sound interchangeable, but they have subtle differences. In general, try to use “may” when something is more likely to happen, and use “might” if something is less likely to happen. For example, “The sky looks really cloudy and gray; it may rain later today” is correct. “The sky looks really cloudy, but it might be sunny tomorrow” is correct. Here’s an easy way to remember: MAY and BIG both have three letters — aka, there’s a BIG chance. MIGHT and SMALL both have five letters — aka, there’s a SMALL chance.
The parent company of CoverMyMeds
An internal division of McKesson’s U.S. pharmaceutical group that’s responsible for the health systems market which includes pharmacies in acute care hospitals, clinics, correctional facilities, HMOs and federal facilities serving veterans and alternative care sites such as LTC facilities.
McKesson provides a comprehensive range of medical-surgical supplies and equipment to physicians’ offices, home care agencies, long-term care facilities and surgery centers. From bandages to exam tables, McKesson’s catalog includes more than 150,000 national brand products along with its own line of quality products.
A division of McKesson which includes McKesson U.S. Pharmaceutical, McKesson Specialty Health, Retail Pharmacy Solutions (Health Mart, AccessHealth, Health Mart Atlas) as well as McKesson Pharmacy Systems, Supplylogix, and MacroHelix.
McKesson Pharmacy Systems and Automation offers clinically driven pharmacy management systems that provide access to pharmacy workflows and also provide a link for pharmacies directly with McKesson Connect. Three platforms are offered to support start-up independents, independent small-medium chains, large chains and outpatient health systems. These are: PharmacyRx, PharmaServ and EnterpriseRx.
U.S. pharma business unit that provides an integration solution for specialty pharmaceutical and plasma products.
McKesson acquired Pharmatek Systems and the combined entity is McKesson RxO (Pharmacy Optimization). The division offers data and analytics to help improve a pharmacy’s clinical, financial and operational performance.
This division of McKesson unites independent providers with manufacturers and payers, strengthening the business foundations of specialty care, delivering end-to-end efficiencies and clinical excellence.
A joint Federal and State program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from State to State but most health care costs are covered if a beneficiary qualifies. The name of the program varies by State but is commonly referred to as the medical assistance program.
There are approximately 42 million Medicare beneficiaries. Of this total, 35 million are seniors aged 65-years or older and the other 7 million are disabled persons and persons with end-stage renal disease. It's estimated that 80% of Medicare beneficiaries have at least one chronic disease, and over half of the Medicare population have two or more. Medicare is federal health insurance for people 65 or older, some younger people with disabilities and people with End-Stage Renal Disease. Understanding Parts A, B and D: Medicare Part A (Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B (Medical Insurance) Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Medicare Part D (Prescription Drug Coverage) Helps cover the cost of prescription drugs (including many recommended shots or vaccines). Of note, Medicare Part D very often requires prior authorization to obtain coverage for certain prescription drugs.
Covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care.
Medical insurance helps pay for physicians’ services, outpatient hospital services, durable medical equipment and supplies that are not covered by Medicare Part A. Inhalant Solutions are covered when used in conjunction with an inhalation apparatus, along with sterile saline used for this purpose. Aerosol inhalers are not covered. Immunosuppressive are covered when the patient has received an organ transplant, but only for a certain time period after surgery [Imuran (Azathioprine) or Prograf (Tacrolimus)]. Oral Antiemetics are covered when their use is required for proper bio-availability of the concomitant antineoplastictherapy (Phenergan–Promethazineor Compazine) −Diabetic Supplies.
Not a separate benefit, but rather the part of Medicare policy that allows private health insurance companies to provide Medicare benefits.
The Centers for Medicare and Medicaid Services (CMS) oversees the Medicare Part D program. The Social Security Administration (SSA) assists CMS in identifying beneficiaries that are eligible for additional assistance based on their income status, also known as “subsidy." Medicare Part D is insurance available to help pay for prescription drug costs for the elderly and disabled entitled to Medicare Part A and /or B.
A service rendered by a pharmacist that provides a comprehensive and in-depth examination of a patient’s medication regimen that helps to ensure proper medication utilization.
The Novartis brand name for their ScriptHero program
note to dev team that this needs populated with the email recipient's name
Some drugs are identified as having a narrow therapeutic index (NTI) by the Food & Drug Administration (FDA). With NTI drugs, small changes in the dosage could cause toxic results. Examples: Carbamazepine Tablets, Oral Suspension Lithium Carbonate Capsules, Tablets, ER Tablets Warfarin, Sodium Tablets, etc.
A 7-digit pharmacy identifier issued by the State Board of Pharmacy.
Represents traditional drug stores, supermarkets, and mass merchants with pharmacies - from regional chains with four stores to national companies. NACDS represents 137 chains that operate these pharmacies in neighborhoods across the United States. Members also include more than 900 pharmacy and consumer packaged goods suppliers and service providers, and over 60 international members from 23 countries. An advocate for pharmacy before all levels and branches of government.
The National Average Drug Acquisition Cost (NADAC) is based on the retail price survey (500 volunteer pharmacies) and focuses on the retail community pharmacy acquisition costs. CMS has mandated that Medicaid pharmacy programs reimburse the actual acquisition cost (AAC) of drugs plus a professional dispensing fee.
Founded in 1898, the NCPA represents America’s community pharmacists, including the owners of more than 22,000 pharmacies. The nation’s community pharmacies, pharmacy franchises, and regional chains dispense approximately 40 percent of the nation’s retail prescription medications. Likewise, they are community leaders actively involved in community-oriented public health, civic, and volunteer projects. Many hold local elected offices; others serve as state legislators. NCPA is the advocate for community pharmacists on the public policy issues that impact their patients and pharmacies. Whether it's at Capitol Hill, state legislatures, regulatory agencies, or the courts, NCPA advocates on issues ranging from PBM abuses to pharmacists’ ability to practice to the full extent of their training.
Governing pharmacy standards organization. Established and maintains electronic pharmacy claims standards (current pharmacy claim version is NCPDP standard D.0).
The 11-digit NDC is the most precise way of identifying a medication. When dispensing prescriptions in the pharmacy, the pharmacy practice management systems use the 11-digit NDC number. The NDC is divided into 3 parts: - The first 5 digits of the NDC identify the manufacturer. - The next 4 digits identify the actual drug. - The last two digits identify the package size of the stock bottle dispensed.
McKesson’s main distribution center located in Memphis, TN, that services other distribution centers, operating as a hub in a hub-and-spoke type system.
An association that's specific to pharmacy buyers and their role within the pharmaceutical industry.
Identifier issued to both pharmacies and prescribers. NABP and NPI numbers are used to track pharmacies plan/payer eligibility, prescriber/pharmacy licensing status, prescriptive authority, etc. NABP and NPI are required in order for pharmacies to transmit claims to third-parties for claim adjudication and subsequent claim reimbursement.
From our LinkedIn ad feedback,"As discussed with Angela legal prefers "most health plans" based on 10-K segment description provided. However, Angela prefers 'nearly every' and is supported by data analytics. Therefore, we can resolve this and leave as "nearly every payer"' - based on 94% prescription volume stat
Use the verb “need” (and not "must") when you’re telling patients something they’re required to do or should do.
generic version of Ilevro
Instead of saying that our prior authorization solution is "free" for providers to use, rephrase the sentence to use "no cost."
A brand-name drug that is not in the formulary and may have different cost involved since it is not covered under the plan.
National Provider Identifier - no need to spell out on first reference.
A specialty pharmacy dedicated to the compounding and dispensing of radioactive material for use in nuclear medicine procedures.
What is a "Nut Graph?" In journalism, the nut graph is a paragraph that succinctly explains the context of the story. You can also think of the nut graph as the “so-what paragraph” that tells the reader why they should care. Typically, nut graphs appear in the third, fourth or fifth paragraphs of a story.
Since its 1976 establishment, OIG has been at the forefront of the Nation's efforts to fight waste, fraud and abuse in Medicare, Medicaid and more than 100 other HHS programs. HHS OIG is the largest inspector general's office in the Federal Government, with approximately 1,600 dedicated to combating fraud, waste and abuse and to improving the efficiency of HHS programs. A majority of OIG's resources go toward the oversight of Medicare and Medicaid — programs that represent a significant part of the Federal budget and that affect this country's most vulnerable citizens. OIG's oversight extends to programs under other HHS institutions, including the Centers for Disease Control and Prevention, National Institutes of Health, and the Food and Drug Administration.
Avoid this adjective when referring to patients
Unless it starts a sentence, always use the lower case version.
Do not use words that identify us as a potential "monopoly."
Payer partner
The publication "Approved Drug Products with Therapeutic Equivalence Evaluations" (commonly known as the Orange Book) identifies drug products approved on the basis of safety and effectiveness by the Food and Drug Administration (FDA) under the Federal Food, Drug, and Cosmetic Act (the Act). A-rated drugs are those which the FDA considers to be therapeutically equivalent and, therefore, substitutable where permitted by the prescriber. B-rated drugs are those which the FDA considers NOT to be therapeutically equivalent due to actual or potential bioequivalence problems which have not been resolved.
A pharmacy that fills prescriptions for patients affiliated with the pharmacy's parent medical institution — typically a hospital or clinic. Usually, these facilities will only fill prescriptions related to medical treatment at the parent facility or one of its outpatient clinics, by contrast with a more conventional pharmacy, which fills prescriptions for anyone. Hospitals usually offer outpatient pharmacy services as a convenience to their patients, and sometimes to staff as well.
A pharmacy that performs compounding of medications for other pharmacies and healthcare institutions.
Drugs not requiring a prescription that are safe and effective for use for the general public without seeking treatment by a medical professional.
The Oxford (or serial) comma is the final comma commonly used in lists. For example: “My favorite foods are cheese, pickles, and noodles.” AP Style — the style guide that newspapers (and CoverMyMeds) follow — does NOT require Oxford commas. Therefore, that sentence should look like: “My favorite foods are cheese, pickles and noodles.” Some Oxford comma proponents argue that its use helps clarify confusing lists. However, it’s typically best to re-write the sentence to be less confusing. For example, “We went to the park with our dogs, grandma and grandpa” can be re-written as “We went to the park with grandma, grandma and our dogs.”
On further reference of prior authorization, use "prior auth" instead of PA.
One of our PA solutions; spell out in all instances.
One of our PA solutions; spell out in all instances.
PA Season, or Blizzard Season, is the period from January to March when prior authorization volume peaks (about 30% of all PA volume comes in this month). DON'T use this term in external use.
Generally we should avoid using "partnership" in talking about our work with third parties and should use "collaboration" instead.
Do not use to refer to ScriptHero customers/users - externally or internally. OK to use when talking about a patient of a provider or pharmacy.
Services offered by pharmaceutical companies for people who can't afford their medications. These programs are available to low-income individuals or families who are underinsured or uninsured. Recipients need to meet eligibility requirements. Such programs are typically funded by foundations maintained by pharmaceutical companies.
Use patient-centered when talking about tools and resources available to the patient. Use patient-driven when talking about patients' demand for what they want to experience. See also: patient-driven
Use patient-driven when talking about patients' demand for what they want to experience. Use patient-centered when talking about tools and resources available to the patient. See also: patient-centered
Generally refers to entities other than the patient that finance or reimburse the cost of health services. In most cases, this term refers to insurance carriers, other third-party payers, or health plan sponsors (employers or unions).
Capitalize always unless it's part of a file name (e.g., Patient.pdf)
An electronic record of healthcare information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.
UPDATE: We say "PHARMA" vs." "BIOPHARMA" when referring to pharmaceutical companies. By definition, the primary difference between biopharmaceuticals and traditional pharmaceuticals is the method by which the drugs are produced: - The former (biopharma) are manufactured in living organisms such as bacteria, yeast and mammalian cells - The latter (pharma) are manufactured through a series of chemical synthesis Our customers are a mix of both and the majority is the traditional method, so "pharma" is a better description for the whole. +++ "Pharma" is a term used internally to refer to our pharmaceutical manufacturer clients and the sales team working within this segment. From a global perspective, "pharma" is used to refer to our largest business segment — pharmaceutical distribution. Pharma distribution is our wholesaler business, acquiring drugs from manufacturers and selling these drugs to pharmacies, physicians, hospitals and clinics nationwide.
Pharmacy benefit managers (PBMs) are national systems, such as Express Scripts, CVS Health, Optum, and Prime Therapeutics/Walgreens, which manage prescription drug benefits on behalf of insurers along with a level of patient support.
In the United States, a pharmacy benefit manager (PBM) is a third-party administrator (TPA) of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), and state government employee plans.
Also called Managed Care Organization (MCO): negotiates and administers contracts between Pharmacy Benefit Managers (PBMs) and independent pharmacies.
Pickup versus pick up verses pick-up. Pickup (one word) is a noun or adjective. Pick up (two words) is a verb phrase. Pick-up has an unnecessary hyphen and can always be replaced by pickup or pick up. Examples: “I need to drive my pickup truck to pick up the groceries.”
An employer benefits program
Extensive rules set developed to support pharmacy business needs within workflow, as they are filling prescriptions. These rules help protect profitability, enhance patient safety, drive medication adherence and reduce audit risk.
Do not hyphenate double-e combinations with pre- and re-, such as pre-existing condition. Other examples include: preeclampsia, preelection, preeminent, preempt and preestablished.
Provides real-time monitoring of claims to determine schedule and narcotic status of a drug or compound and whether the DEA number has the authority to write for that drug.
An instruction written by a medical practitioner that authorizes a patient to be provided a medicine or treatment.
This division of McKesson includes: RelayHealth, Prescription Automation, RxCrossroads and CoverMyMeds.
Acceptable to use after first use of "prior authorization."
Prior authorization is a requirement that physicians obtain approval from healthcare providers before prescribing a specific medication or to performing a particular operation. Without this prior approval, the health insurance provider may not provide coverage, or pay for the medication or operation. Used by third-party payers to control costs.
One of our PA solutions; spell out in all instances.
The Processor Control Number (PCN) is a secondary identifier that may be used in the routing of pharmacy transactions. A PBM/processor/plan may choose to differentiate different plans/benefit packages with the use of unique PCNs. The PCN is defined by the PBM/processor as this identifier is unique to their business needs.
The legal document that's required through the MyChoiceRx program. This letter goes to the patient's insurer to let them know they are participating in the MyChoiceRx program and won't be using their insurance to get their medication. The name for this document used to be Attestation. It is now Program Agreement.
Protected health information (PHI) under U.S. law is any information about health status, provision of healthcare, or payment for healthcare that is created or collected by a "Covered Entity" (or a Business Associate of a Covered Entity), and can be linked to a specific individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history.
We define “provider” as a prescriber and any member of their care team, inclusive of nurses, medical assistants, office managers and prior authorization specialists.
The certification of a medical professional group that gives them permission to participate in Medicare Part B, which generally allows them to receive compensation for their services from federal, state and private healthcare plans.
Real time (two words) is a noun. Real-time (hypen) is an adjective. For example: “CoverMyMeds’ technology submits ePA requests in real time.” “CoverMyMeds’ users get real-time updates on their ePA requests.”
RTBC stands for "real-time benefit check." Spell out "real-time benefit check (RTBC)" on first instance, then use RTBC.
Compensation for a pharmacy service.
RelayHealth is now part of CoverMyMeds as of 4.27.21. RelayHealth historically has been a pharmacy switch used to "carry" the MyChoiceRx identifiers from the dispensing pharmacy to LoyaltyScript. LoyaltyScript is the program that verifies the identifiers to process the claim and reimbursement for the dispensing pharmacy.
The name of McKesson’s segment that includes large chain pharmacies. These businesses can range in size from chains with 41-7,100+ pharmacy locations and include pharmacy chains, supermarkets, mass merchants and other providers chains with pharmacies onsite.
Validates that patients, pharmacies, physicians, and distributors are properly educated on the risks of drugs such as fast-acting opioids. Validates drugs are properly prescribed and prevents off-market distribution (i.e. on the street as mandated by the FDA).
Our real-time benefit check solution; spell out in all instances.
RxCrossroads is now part of CoverMyMeds as of 4.27.21. As a solution, RxCrossroads advocates for patient access and adherence by creating flexible, connected solutions that support each phase of a product life cycle and each milestone of the patient journey.
RelayHealth version of ScriptHero and ScriptSave. Future will hopefully be using Savings Seeker as an API and using RelayHealth's pharmacy network and relationships. This won't necessarily be a replacement to ScriptSave but work alongside it so we always render the cheapest price to the consumer. It will also be a good backup if ScriptSave were to ever go down. Savings Seeker will be the go-to place for DTC brands. RH thinks that SH is unfriendly to pharmacies and they think their version will be liked more by pharmacies and won't ruin their established relationships that their business is built on. This network will also also us to bypass using the LoyaltyScripts copay card network which to pharmacists is confusing b/c they don't always know to apply it as a discount card vs. a traditional copay card program.
A term used by all licensing boards that defines the procedures, actions and processes that are permitted for the licensed individual under the law.
ScriptHero Marketplace is the iOS application (app) and website that patients use to access price transparency for medications, and as such, is a vital part of our solution. But it can cause confusion with patients. When we are speaking with users, avoid referring to the "ScriptHero Marketplace" if possible and use "ScriptHero" instead. If necessary, say it more generically (e.g., "We have a nationwide marketplace of pharmacies for you to compare prescription prices...")
ScriptHero Pharmacy is a vital part of our solution -- as a non-dispensing, fully licensed pharmacy that processes prescriptions for patients. But it can cause confusion to patients. When we are speaking with users, avoid referring to the word "pharmacy" if possible and use ScriptHero instead. If necessary, say we have a team of pharmacists on-hand for clinical issues.
The term we use to refer to our Network Services partners. These are the folks on the front lines talking to our patients and helping them with any ScriptHero-related issues they might be experiencing.
ScriptSave is the first non-sponsored discount card program for ScriptHero. ScriptHero partners with ScriptSave to provide patients with discount cards and price transparency. In order for a dispensing pharmacy to populate in the ScriptHero for non-sponsored drugs, they must be participating in the ScriptSave program.
Use the verb “select” (1) when telling patients to pick something from a limited number of options of the same kind; (2) when patients need to make an easy or obvious decision that doesn’t require deep reflection or analysis; (3) for defined lists and dropdown menus; (4) when patients are given the option to pick from a list of already existing objects, like products.
You might think that “simple” and “simplistic” are synonyms, but they’re not. Definition of “simple” — easily understood or done, presenting no difficulty; plain, basic, or uncomplicated in form, nature, or design; without much decoration Definition of “simplistic” — excessively simple or simplified; treating a problem or subject with false simplicity by omitting or ignoring complicating factors or details As you can see, “simple” is merely descriptive, whereas “simplistic” is more pejorative.
An inpatient healthcare facility with the staff and equipment to provide skilled care, rehabilitation and other related health services to patients who need nursing care, but do not require hospitalization.
Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
A recent designation of pharmaceuticals that are classified as high-cost, high complexity, and/or high touch. Specialty drugs are often biologics – “drugs derived from living cells” that are injectable or infused (although some are oral medications). They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, HIV, psoriasis, inflammatory bowel disease (IBD), and Hepatitis C.
Focuses on providing services to patients with rare conditions, who require high-cost, complex medications, frequently only available from a limited panel of specialty pharmacies.
When talking about CMM products, don't use the word "streamline." Instead, use "simplify" or "automate." Note from legal: The reason we want to stay away from using the word "streamline" when describing our programs and services is because it's not technically an accurate statement and could mislead the audience, which then may have some AKS (Anti-Kickback Statute) violation implications. Using words like "automate" or "simplify" are more direct descriptors of what our programs and services do for HCPs and patients. If we use "streamline" the HCP or other audience would have to make more of an inference on what streamline means, and they could infer that to mean something we don't want them to infer. - Simplify - YES. OK TO USE - Automate - YES, OK TO USE
Subject lines can make or break an email campaign’s success. Here are a few best practices to keep in mind from MailChimp: - Add personalization (if possible) with merge tags. - Be descriptive and call attention to specific details. - Short is best — no more than 9 words/60 characters. - Limit punctuation marks — too many looks like spam. Use emojis sparingly to supplement words, not replace them. For a deeper dive, check out the full story: https://mailchimp.com/help/best-practices-for-email-subject-lines/
Though we always describe patient challenges and illnesses with empathy -- and show that we understand the seriousness of these -- we don't describe patients as victims of their health or their healthcare. We do not use words like "suffer."
Though we always describe patient challenges and illnesses with empathy — and show that we understand the seriousness of these — we don't describe patients as victims of their health or their healthcare. We do not use words like "suffering."
Supplylogix gives pharmacies the power to take control of their pharmacy supply chain with a suite of tools that provides unprecedented insights to help reduce costs and increase efficiency. Supplylogix has helped over 12,000 pharmacies achieve: - Over $665 million in hard dollar customer savings and growing - 25% Reduction in Unusable Returns - 35% Inventory Turn Improvements Essentially, they make it possible for pharmacies to transfer inventory between pharmacy locations to ensure it's used when at risk of expiring. They also have tools that help with cycle counts and monitoring of controlled substances.
Surescripts is an Arlington, Virginia-based information technology company that supports e-prescription, the electronic transmission of prescriptions between healthcare organizations and pharmacies, as well as general health information exchange of medical records.
Another name for a network service provider. Intermediary connecting healthcare entities such as pharmacies, payers, prescribers, hospitals and health systems for the exchange of healthcare information.
Routes prescription claims from pharmacies to third parties for claims adjudication. Examples include: RelayHealth, eRx and QS1.
We can say "tailored approach" or "tailored recommendations" but we CANNOT say "tailored solutions" because we do not create custom or tailored solutions for clients. We have a suite of out of the box solutions that clients can choose from and potentially configure to meet their needs.
On capitalizing internal elements of an organization like our “Patient Services” team at CoverMyMeds, here’s what AP says: Use lowercase for internal elements of an organization when they have names that are widely used generic terms: the board of directors of General Motors, the board of trustees of Columbia University, the history department of Harvard University, the sports department of the Daily Citizen-Leader. Capitalize internal elements of an organization when they have names that are not widely used generic terms: the General Assembly of the World Council of Churches, the House of Delegates of the American Medical Association, the House of Bishops and House of Deputies of the Episcopal Church. So, our Patient Services team would be capitalized, but our marketing team would not be.
Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.
Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.
Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.
THAT or WHICH? "That" is used to indicate a specific object, item, person, situation, etc. "Which" is used to add information to objects, items, people, situations, etc. Because "which" indicates a non-restrictive (optional) clause, it’s usually set off by commas. For example: “CoverMyMeds offers technology solutions that allow providers to save time and help patients” is CORRECT “CoverMyMeds' technology solutions, which allow providers to save time, also help patients” is CORRECT
CoverMyMeds has five target audiences: - Patients - Providers - Pharmacists - Payers - Pharma
They're vs. there vs. their They sound the same, but their meanings are different. “They’re” is a contraction of “they are” - Example: They’re going to the store. “There” typically refers to a location - Example: I want to go there. “Their” shows ownership of something - Example: It’s their new house. Now let’s use them all in a sentence, just for fun: “They’re going over there to pick up their cat.”
An individual or firm hired by an employer to handle claims processing, pay providers, and manage other functions related to the operation of health insurance. The TPA is not the policyholder or the insurer.
A pharmacy audit is a formal review of operations and processes to make sure that pharmacies are compliant with pharmacy regulations and other related agreements. TYPES OF AUDITS: Field/On-Site Audits Field/On-site Audits are performed at the pharmacy and involve physical observations, prescription reviews, inventory, and checks for compliance with Medicare Part D regulations and procedures. The pharmacy usually receives advance notice, but in some rare instances, they can be unannounced, such as for Medicaid. Such audits generally cover claims from the previous 12- 18 months and provide you with a range of prescriptions to have readily available beforehand. Purchase Verification Purchase Verification Audits review the amounts and NDCs of medications that are submitted by pharmacies from wholesale receipts. They are investigational-type audits and are conducted in accordance with Third Party Payer agreements. Investigational Audit A pharmacy is usually contacted by phone or mail and asked to provide photocopies of specific documents and records related to claims paid to pharmacy during a specified period. Documentation may include copies of original prescriptions, signature logs, computer records, and invoices showing purchase or receipt of dispensed medications. These can be as simple as comparing NDCs ordered versus those dispensed to a complex investigation about prescriber, member or pharmacy fraud. Desk/Mail Audits Desk/Mail Audits use automated means to review pharmacy claims and encounter data received by the plan or PBM. This type of audit requires the pharmacy to locate prescription records and send them to the PBM. It's set up to evaluate prescribing patterns, physician referral patterns, utilization overrides, ingredient cost integrity, geographic prescribing reports, payment reports, and billed issues to identify possible abusive or fraudulent activity. Prescriber/Member Audits Prescriber Audits have specific claim information submitted by the pharmacy and are then thoroughly verified by a prescriber/physician to ensure that each party’s records coincide. It's essentially handled the same as a Desk/Mail Audit. Member Audits Member audits are similar to the Prescriber Audit with the exception that the corresponding claims are verified with the patient/customer verification. It's essentially handled the same as a Desk/Mail Audit. Telephone Audits The PBM contacts the pharmacy usually to correct claim billing on a single or small number of claims. It isn't used for large volumes of claims. Failure to comply with a telephone audit will normally result in the PBM reversing the claim and could lead to a desk or on-site audit.
To lower costs, a plan places prescription drugs in its formulary into different "tiers." Your drug copay will vary depending on the tier. For example, one approach to tiers is the following: Tier 1: Generic drugs Tier 2: Preferred brand drugs Tier 3: Non-preferred brand drugs Tier 4: Specialty drugs
Per AP Style, use lowercase a.m. and p.m. — with periods — when writing the time. If it’s an exact hour, no “:00″ is required. For example, “I wake up at 6 a.m. before the sun rises, then get in bed at 9:30 p.m. to read a book.”
Title Case vs. sentence case, when to use. Our brand guidelines call for Title Case formatting for all H1, or main, headlines. Subsequent headlines, like H2s or H3s, should be sentence case. Title Case: This is a Title Case Headline. Sentence case: This is a sentence case headline. If you want to double-check your work, Capitalize My Title is a great tool. Reminder: we follow AP style.
Total amount to be paid by the claims processor (i.e. pharmacy receivable). Represents a sum of ‘Ingredient Cost Paid’ (5Ø6-F6), ‘Dispensing Fee Paid’(5Ø7-F7), ‘Flat Sales Tax Amount Paid’ (558-AW),‘Percentage Sales Tax Amount Paid’ (559-AX), ‘Incentive Amount Paid’ (521-FL), ‘Professional Service Fee Paid’(562-J1), ‘Other Amount Paid’ (565-J4), less ‘Patient Pay Amount’ (5Ø5-F5) and ‘Other (565-J4), less ‘Patient Pay Amount’ (5Ø5-F5) and ‘Other Payer Amount Recognized’(566-J5).
Refers to the National Council for Prescription Drug Programs (NCPDP) pharmacy claims bundle. (4) pharmacy claims may be bundled into (1) transaction for a single patient.
Brand-name drug from Novartis that's used in ScriptHero's brand-direct program
generic version of Travatan Z
[Total or] True out-of-pocket (TrOOP) costs are the expenses that count toward a person’s Medicare drug plan out-of-pocket threshold. TrOOP costs determine when a person’s catastrophic coverage portion of their Medicare Part D prescription drug plan will begin.
Balance transfer to the Medicare Part D network facilitator system. Allows for the real-time routing of Medicare Part D TrOOP and Total Drug Spend Balances between PBMs. Automatically transfer’s a beneficiary’s balance between one Part D plan and another, when the beneficiary changes PBMs. Implemented a new Telecommunications Standard, Financial Information Reporting (FIR) V1.0.
Merriam-Webster: Not covered by insurance or included in a social insurance or welfare program. This term can apply to a person or to a medical treatment or evaluation. See also: covered
Though we always describe patient challenges and illnesses with empathy -- and show that we understand the seriousness of these -- we don't describe patients as victims of their health or their healthcare. We do not use words like "unhealthy."
Though we always describe patient challenges and illnesses with empathy -- and show that we understand the seriousness of these -- we don't describe patients as victims of their health or their healthcare. We do not use words like "unwell."
This should only be used in internal communications. Don't refer to our "users" as users - the association to drug users is too close.
Usual and Customary (U&C): Pricing field required by third-party payers within an NCPDP D.0 pharmacy claim. U&C should reflect a pharmacy’s published cash price (what they charge the uninsured to fill a prescription).
Pay-for-performance program differentially rewards or punishes hospitals (and likely ASCs and physicians in coming years) based on performance against pre-defined process and outcome performance measures.
When writing about a person with disabilities, don’t use the words “suffer,” “victim,” or “handicapped.” Emphasize the person first—don’t call a person with a medical condition a “victim.” “Handicapped parking” is OK.
Use with caution. We use this word in specific terms of what people are vulnerable to, as in "vulnerable to developing heart disease." We don't use this word to broadly describe individuals or populations.
Unless it starts a sentence, always use the lower case version.
Who’s vs. whose Who’s and whose sound the same, but they have different meanings. - Who’s is a contraction of “who is” or “who has” - Whose means “belonging to whom” or “of which” For example: - “Who’s hungry for a sandwich?” is CORRECT! - “Whose turkey sandwich is that?” is CORRECT! If you’re ever on the fence about which one to use, try replacing who’s/whose with “who is” or “who has” in your head. If the sentence no longer makes sense, use “whose.”
The price paid by a wholesaler for drugs purchased from the wholesaler's supplier, typically the manufacturer of the drug. On financial statements, the total of these amounts equals the wholesaler's cost of goods sold. Publicly disclosed or listed WAC amounts may not reflect all available discounts.
A wholesaler usually distributes drugs to retail community pharmacies, manufacturers, re-packers, distributors, own-label distributors, private-label distributors, jobbers, brokers, warehouses, independent wholesale drug traders, and retail community pharmacies who conduct wholesale distribution.
By “workflow” we mean the way in which a prescription enters the pharmacy, moves through the filling process, and ends up correctly in the hands of the appropriate patient.
Avoid this adjective when talking about patients