Investor Presentaiton
Dispensing fee
Drug manufacturer
Drug rebates
Fee-for-service (FFS)
Fiduciary
Generic drug
Mail order pharmacy
Maximum allowable cost
National Average Drug Acquisition
Cost
The professional fee which:
(1) Is incurred at the point of sale or service and pays for costs in excess of the
ingredient cost of a covered outpatient drug each time a covered outpatient
drug is dispensed;
(2) Includes only pharmacy costs associated with ensuring that possession of
the appropriate covered outpatient drug is transferred to a Medicaid
beneficiary. Pharmacy costs include, but are not limited to, reasonable costs
associated with a pharmacist's time in checking the computer for information
about an individual's coverage, performing drug utilization review and
preferred drug list review activities, measurement or mixing of the covered
outpatient drug, filling the container, beneficiary counseling, physically
providing the completed prescription to the Medicaid beneficiary, delivery,
special packaging, and overhead associated with maintaining the facility and
equipment necessary to operate the pharmacy.
Any person or firm which manufactures, compounds, or packages a drug for
wholesale in the pharmaceutical form in which it is sold by retail to the public.
These are provided by manufacturers and are typically based on the ability of a
payer to move market share for the manufacturer's product. Rebates are
confidential. Rebates are billed periodically by the insurer or PBM based on
drug utilization subject to the rebate. Rebates allow the manufacturer to retain
a high list price (which can be important to the manufacturer so any US price
that might wind up in the reference pricing system of another country is high).
A method/model in which doctors and other health care providers are paid for
each service performed directly by OHA (not through a CCO).
A fiduciary is a person or entity who holds a legal or ethical responsibility to act
in the best interests of their clients.
Competitors to a branded product that has an expired patent. Generics are
considered identical to the brand product.
A pharmacy located within a U.S. jurisdiction whose primary business is to
dispense a prescription drug or device pursuant to a valid prescription drug
order and to deliver the drug or device to a patient via the United States
Postal Service, a common carrier, or a delivery service. "Mail order pharmacy"
includes a pharmacy that does business via the internet or other electronic
media.
The average price of all the multisource drugs in a group. The frequency the
maximum allowable cost is recalculated is at the discretion of the payer. The
multi-source drugs to which a maximum allowable cost is applied is also at the
discretion of the payer.
A national average of the prices at which pharmacies purchase a prescription
drug from manufacturers or wholesalers, including some rebates.
Oregon Secretary of State | Report 2023-25 | August 2023 | page 37View entire presentation