Iyi inotevera Pharmacy Benefit Management, Medicare, uye Medicaid Reimbursement mazwi anorondedzerwa muhuwandu hwemafabheti, achivhara mazwi mashoma. Ndapota cherechedza kuti mazita acho ndeayawo ari kure nezwi rakazara reinshuwarisi sezvo zvichiita kuva.
Average Manufacturer Price (AMP)
AMP ndiyo nheyo yekubhadhara mishonga yemishonga kumapromasi pasi peMedicaid.
ICenter for Medicare & Medicaid Services inotsanangura izvi sezvo vese vendesa vanobhadhara vatengesi vezvinodhaka, uye haisi chairo chaiyo yebhadharo yemishonga yemishonga. Iyo sangano inoshandisa kuyerwa kwezvinhu kune yakasvibirira dollar maitiro anorondedzerwa imwe neimwe yehurumende yemari inotangira chikamu ichibva kune chikamu uye nzira yehutungamiri, zvino inodhura hutsika hunorema mumutsetse kuti uverenge federal kumusoro kwepamusoro (ona pasi apa). FUL ndiyo nhamba chaiyo yeMedicaid.
Avhareji yekutengesa Mutengo (ASP)
ICMS inoshandisa ASP seyo nhamba huru kuverenga kubhadharwa kwezvinodhaka zvakadhindwa pasi peMedareti Chikamu B. Chero roga roga, mutengesi wezvinodhaka wese anobvumirwa neU.S. Food and Drug Administration anofanirwa kuudza kuCMS mutengo wepamusoro inoshandiswa pamutengo mumwe nomumwe unotengesa kune vatengesi, zvipatara, uye ma pharmacy . IAP inopesana kubva kuma AMP kunyanya kuve yakakwirira. Chiyero ichocho chinobva kune chokwadi icho ASPs hachina kugadziriswa pamutengo wemuchina kana mutengi.
Avhareji Wholesale Price (AWP)
PBMs nemakambani ehutano inshuwarhu anotadza zvikuru kuvimba neAWP kuverenga madhiragi emitengo yemari yekubhadhara. Izvo zvakafanana zvakafanana ne AMP nokuti mishonga inogadzira mishonga inoshandisa nzira imwechete yekuzivisa maitiro. Ivhareji yezvokutengesa zvipi zvekubhadhara michina zvinowanzosiyana neAmP, kunyange zvakadaro, sezvakakurukurwa pasi apa.
Thompson Reuters inogadzira uye inoparidzira AWPs gore negore muRub Book .
Kupa Mari
Kubhadhara mari inowanikwa kune chibereko chemari yekubhadhara mari yekuvhara mari yekudavira kwemishonga yekuita bhizinesi nekupa kurapa kwevarwere nekupa mazano. Sangano reNational Association of Chain Drugstores rinorondedzera mari iyo seyokusanganisira vashandi vemari, kubhadhara mari kana kubhadhara mari, kubhadhara mishonga yemishonga, kupa zvinyorwa zvinyorwa kuvarwere uye kusangana nemumwe chete nevarwere. Kubhadhara mari, iyo inopesana nerudzi rwechigadzirwa uye inogona kutaurirana nevatsigiri vevamwe vega kana kuti yakagadzirirwa zvirongwa zvehutano zvehurumende, inofanirawo kubvumira purogiramu duku kudhipatimendi. Icho hachisi nguva dzose uye chiri kuramba chichiwedzera kusanyengera pasi peMedicaid sekuti nyika inotarisira kuchengetedza mune purogiramu inowanzova iyo imwe huru yebhajiti chinhu.
Federal Federal Limit (FUL)
CMS inotarisa FUL yemishonga yakawanda inoparidzirwa kuMedicaid inobatsirika nekuwedzera chikwata cheMPP ne 175%. Chirongwa cheMurwere Kudzivirirwa uye Affordable Care Act, kana Obamacare, zvishoma zvishoma zvinokonzerwa neFUL reimbursement zvinoshandiswa zita rechirwere nemishonga yemishonga uye mishonga yemishonga inowanika inowanika kubva kune anopfuura mumwe mugadziri. Zvinonzwisisika, zviti hazvifaniri kubhadhara FUL reimbursements mumamiriro ose.
Murairo unonzi huwandu hwekugadziriswa mari, kana MAC, unogona kushandiswa pamigetsi yemishonga yemishonga inogadzirwa.