Lezi zilandelayo ezilandelayo zifakwe ohlwini lwe-alfabhethi, i-Pharmacy Benefit Management, i-Medicare, ne-Medicaid yokubuyisela. Sicela uqaphele ukuthi lolu hlu lubuye lube noluseduze ne-glossary olunzulu yemigomo yomshuwalense njengoba kungenzeka.
Isilinganiso sempahla yomkhiqizi (AMP)
I-AMP yisisekelo sokukhokhelwa kwezidakamizwa zemithi e-pharmacy ngaphansi kweMedicaid.
Amasevisi WezeMithi & Medicaid Services achaza lokhu njengalokho abathengisi bezinkokhelo bakhokha abakhiqizi bezidakamizwa, futhi akusikho isilinganiso esiyiqiniso sokukhokha kwemikhiqizo yezidakamizwa. I-ejensi isebenzisa izici zokulinganisela emazingeni amancane we-dollar abike ngekota ngayinye yezimali zentela esekelwe kwisigaba nomzila wokuphatha, bese ixhuma amanani alinganiselwe kufomula ukubala umkhawulo ophezulu wesifundazwe (bheka ngezansi). I-FUL yinombolo yangempela yokukhokha kwe-Medicaid.
Inani lokuthenga eliphakathi (ASP)
I-CMS isebenzisa I-ASP njengenombolo eyinhloko yokubala ukubuyisela izidakamizwa ezikhokhwa ngaphansi kweMedricare Part B. Ngalinye ikota, wonke umuthi wezidakamizwa ogunyazwe yi-US Food and Drug Administration kumele abike ku-CMS intengo ejwayelekile ithengiswa umkhiqizo ngamunye ithengisa kubanikazi, izibhedlela, nama-pharmacy . I-ASP ihluke kwi-AMP ngokuyinhloko ngokuphakama kancane. Lokohluko uvela emaqinisweni ukuthi i-ASP ayilungiswanga uhlobo lomkhiqizo noma umthengi.
Isilinganiso samanani e-Wholesale (AWP)
Ama-PBM nezinkampani zomshuwalense wezempilo zincike kakhulu ku-AWP ukubala amanani okubuyiselwa komkhiqizo wezidakamizwa. Kufana ncamashi ne-AMP ngoba abakhiqizi bezokwelapha basebenzisa indlela efanayo yokubika amanani. Isilinganiso salokho abanikazi bamazwe abakhokha imikhiqizo ngokuvamile bahluke kwi-AMP, noma kunjalo, njengoba kuxoxwe ngezansi.
I-Thompson Reuters iqoqa futhi ishicilela i-AWPs njalo ngonyaka ku- Red Book .
Ukunikezwa Imali
Ukukhokhela izimali zengeziwe kumazinga okubuyiselwa komkhiqizo ukumboza izindleko zekhemisi zokwenza ibhizinisi nokunikeza ukunakekelwa kwesiguli nokululekwa. I- National Association of Chain Drugstores ibeka lezo zindleko njengokubandakanya imiholo yabasebenzi, ukukhokhelwa kwemali noma yokuqashiswa kwemali, imikhiqizo yezidakamizwa zokupakisha, ukuhlinzeka ngolwazi oluphrintiwe ezigulini nokuhlangana nomunye neziguli. Ukuhlinzekela izimali, ezihluka ngohlobo lomkhiqizo futhi zingxoxisana nabashuwalense abazimele noma ezibekwa izinhlelo zezempilo zikahulumeni, kufanele futhi zivumele inzuzo encane yekhemisi. Lokho akulona kunjalo njalo futhi kuqhubeka ngokungahambi kahle ngaphansi kwe-Medicaid njengoba amazwe efuna ukulondoloza ohlelweni oluvame ukufaka into ebhajethi eyodwa kunazo zonke.
I-Limit High Limit (FUL)
I-CMS ibala i-FUL yemithi eminingi enikezwa umzuzi weMedicaid ngokuphindaphinda i-AMP yomkhiqizo ngu-175%. Ukuhlinzekwa koMthetho Wokuvikelwa Kweziguli kanye noMthetho Wokunakekelwa Okunakekelwayo, noma i-Obamacare, amanani okubuyisela e-FUL okulinganiselwe ezidakamizwa zegama lomkhiqizo nemithi yemithi ejwayelekile yokuthola imithi etholakalayo evela kumkhiqizi ongaphezu kweyodwa. Okuphawulekayo, akudingeki ukuthi amaholo athi akhokhele ukubuyiselwa kwe-FUL kuzo zonke izimo.
I-formula ebizwa ngezindleko ezingavumelekile ezingaphezulu, noma i-MAC, ingasetshenziswa emikhiqizweni yemithi yokwelapha ejwayelekile.