Pharmacy reimbursement definition

Pharmacy reimbursement means the amount paid to a pharmacy by a pharmacy benefit manager for a dispensed prescription drug or prescription device.
Pharmacy reimbursement means the amount paid to a pharmacy by a pharmacy benefits manager or coordinator for a dispensed prescription drug.

Examples of Pharmacy reimbursement in a sentence

  • If a Member purchases COVID-19 OTC tests without a prescription from a non-Participating Pharmacy, reimbursement is limited to a quantity of 8 tests per month and up to $12 per test.

  • Pharmacy reimbursement under Medicare has also been shifted from direct billing by the pharmacy to a negotiated rate structure between skilled nursing centers and the pharmacy, with the skilled nursing centers Medicare reimbursement being based upon a prospective rate not related to actual patient pharmaceutical usage.

  • Pharmacy reimbursement – a higher spread translates into higher reimbursement to retailers and mail order pharmacies.

  • Silverman, Ed, Pharmacy reimbursement often lags for generics undergoing price hikes, jeopardizing patient access,STAT, April 14, 2020.

  • Pharmacy reimbursement" means the amount paid to a pharmacy by a pharmacy benefit manager for a dispensed prescription drug or prescription device.

  • Participating Pharmacy reimbursement calculation for each claim submitted will be accomplished by applying Board’s Benefit Plan-specific algorithms which will cover various combinations of formulary inclusion/exclusion, Copayment amounts, refills, etc, if applicable.

  • Although the research team’s quantitative analyses have so far found no statistically significant differences between the intervention group and comparison groups, some improvement was evident in the following areas: • Medication adherence,• Pharmacy reimbursement savings, and• Fewer hospitalizations and lower likelihood of emergency department visits.

  • In addition, You will be responsible for the excess dollar amount between the Participating Pharmacy reimbursement amount and the cash price of the Prescription Drug.

  • Only bidders with audited accounts would be considered for evaluation.

  • Pharmacy reimbursement shall be based on rates listed in Attachment A less any co-payment (all as calculated via the electronic Claim submission system).

Related to Pharmacy reimbursement

  • Medical Reimbursement Programs means a collective reference to the Medicare, Medicaid and TRICARE programs and any other health care program operated by or financed in whole or in part by any foreign or domestic federal, state or local government.

  • Expense Reimbursement has the meaning set forth in Section 8.2(c).

  • Cost Reimbursement means a contract which provides for a fee other than a fee based on a percentage of cost and under which a contractor is reimbursed for costs which are allowable and allocable in accordance with the contract terms.

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Medical Expenses means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.

  • Health care expenses means, for purposes of Section 14, expenses of health maintenance organizations associated with the delivery of health care services, which expenses are analogous to incurred losses of insurers.

  • Routine patient care costs means Covered Medical Expenses which are typically provided absent a clinical trial and not otherwise excluded under the Policy. Routine patient care costs do not include:

  • Medical Expense means an expense incurred at the time a past member or his or her health reimbursement account dependent is furnished the medical care or service. To be considered a medical expense under this act, the expense shall meet all of the following conditions:

  • Reimbursement Payment shall have the meaning given to that term in Subparagraph 2.02(c).

  • Medical evaluation means the process of assessing an individual's health status that includes a medical history and a physical examination of an individual conducted by a licensed medical practitioner operating within the scope of his license.

  • Medicare eligible expenses means expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.

  • Pricing and Reimbursement Approval means the approval, agreement, determination or decision from a Regulatory Authority establishing the price and/or reimbursement for Licensed Product for sale in a given country or regulatory jurisdiction of the Territory, as required by Law in such country or other regulatory jurisdiction prior to or subsequent to the marketing and sale of Licensed Product in such country or regulatory jurisdiction of the Territory.

  • Advanced practice nurse means a person who holds current certification as nurse practitioner/clinical nurse specialist from the State Board of Nursing.

  • Medical examiner means that term as defined in 49 CFR 390.5.

  • Reimbursement means that DOH will repay the Contractor for allowable costs incurred under the terms of this contract.

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Reimbursement insurance policy means a policy of insurance

  • Advance Reimbursement Amounts As defined in Section 3.29 hereof.

  • Cost-reimbursement contract means a contract under which a contractor is reimbursed for costs which are allowable and allocable in accordance with the contract terms and the provisions of this code, and paid a fee, if any.

  • Medical flexible spending arrangement means a benefit plan

  • Advance health care directive means a power of attorney for health care or a record signed or authorized by a prospective donor containing the prospective donor’s direction concerning a health care decision for the prospective donor.

  • Medical malpractice insurance means insurance against legal liability incident to the practice and provision of a medical service other than the practice and provision of a dental service.

  • Pharmacy care means medications prescribed by a licensed physician and any health-related services considered medically necessary to determine the need or effectiveness of the medications.

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • Medicare cost report means CMS-2552-10, the cost report for electronic filing of