1. PHARMACY TECHNICIAN
CHAPTER NINE

2. Purchasing Systems
Independent purchasing—pharmacy director is responsible for written contracts with each pharmaceutical manufacturer
Group purchasing—pharmacy joins an organization that contracts with pharmaceutical manufacturers collectively for all members

3. Methods of Purchasing
Direct—pharmacy buyer places separate orders with each pharmaceutical company and receives separate shipments
Wholesale—pharmacy purchases a large number of products from various manufacturers from a single source
Primary vendor—pharmacy contracts with a single vendor
Comes with all of the benefits of using a wholesaler
Often better pricing and service terms
May have dollar-volume commitment and purchasing restrictions

4. Formularies A listing of drugs approved for a specific purpose
Formularies can be used as:
Reference manuals
Recommendations for prescribing
Strict parameters for medications stocked and approved for reimbursement

5. Process of Ordering Medications
Varies slightly based on the purchasing system and supplier(s)
The key steps in ordering medications are:
Generate order (may be automated or manual system, or combination of both)
Review order (scan to see if order is correct)
Confirm order (make any corrections necessary)
Submit order (electronically or by telephone)

6. Receiving an Order
Accept delivery of the order (via employed courier in secured plastic totes)
Verify the order (the packing list, the invoice, and the actual order are reconciled)
Adjust the inventory (computer system automatically updates inventory levels based on shipment delivered)
Stock the order (medications must be stored according to the specifications of the manufacturer)
File the paperwork concerning the order (pharmacy must keep records of each order placed and received)

7. Returns Typically related to one of following reasons: Expired drugs
Manufacturer recalls
Overstocked/undesired products
Incorrect product sent by supplier
Item incorrectly ordered
Product returned must be in its original condition
Each supplier has specific procedure for handling returns

8. Medicaid and Medicare
Medicaid—government health insurance program for individuals and families with low incomes or members with disabilities; eligibility requirements are determined and vary by state
Medicare—government health insurance program for individuals aged 65 or older, younger people with disabilities, and people with ESRD; provides hospital, medical, and prescription insurance

9. Insurance Terms
Adjudication—process of transmitting a prescription electronically to the proper insurance company or third-party biller for approval and billing
Carrier/Insurer/Provider—the patient’s insurance company
Processor—company hired by the insurer to process claims
Claim—request for reimbursement from a healthcare provider to an insurance provider, for products or services rendered
Co-pay—portion of the cost of a service or product that a patient pays out of pocket each time the service or product is provided

10. Insurance Terms (cont.)
Deductible—a set amount a client pays up front before insurance coverage applies; may be paid at once or in parts
DAW (Dispense As Written)—used by prescribers to instruct the pharmacy to use the exact drug written (usually a brand-name drug)
Days supply—number of days a dispensed quantity of medication will last

11. Collecting Data for Insurance Purposes
Information gathered must exactly match the information that the insurance company has on file
Correct name - Correct address
Marital status - Date of birth

12. Transmit a Prescription for Insurance
First ensure that the patient profiles match
The insurance provider will need to know:
Name of the medication being dispensed (which is matched against a formulary; the insurance provider will only pay for approved medications)
Strength and dose of medication
Whether a generic alternative is available

13. Common Insurance Billing Errors
Continue gathering information when errors occur
Incorrect name—may be due to nicknames, marriage, or divorce
Incorrect days supply—will affect refill times and insurance reimbursements
Incorrect provider—because of changes in employment or employer benefits
Incorrect birth date—may be entered incorrectly for a number of reasons