Acute Medications – see Short Term Medications
Aging Concerns – A pharmacy discount program designed for individuals who are without pharmacy prescription benefit coverage or those who have reached their pharmacy benefit maximum on their pharmacy benefit plan issued by a third party payer.
Alternative Drug Formulary List – A listing of non-formulary drugs with their formulary options, listed by the most common therapeutic categories.
Bio-injectable or specialty medication – High-cost, injectable, oral, infused or inhaled medications that are either self-administered or administered by a healthcare provider, and used or obtained in either an outpatient or home setting.
Catholic Charities – A prescription discount program designed for individuals who are without pharmacy prescription benefit coverage.
Claim History – A participant’s history of prescriptions filled through LDI’s benefit program; usually encompasses medication, quantity, fill date, location, physician and approval or rejection status of the fill.
Co-payment – A dollar amount required of members in order to receive benefits.
Coordination of Care – The process in which participants are supported and implemented into the specialty pharmacy program, including contact with participants physician to obtain pertinent medical information, ensuring appropriateness of medication therapy, enrolling the patient in an automatic refill program when necessary and providing education and resources on medication administration and chronic conditions.
Disease Management – Refers to programs designed to enhance the well being of a participant’s health, as well as their economic and personal lives, through wellness programs, health and lifestyle tools and coordination of care.
FDA – United States Food and Drug Administration
Formulary – A list of drugs that a plan covers, which usually includes generic drugs, preferred brand and non-preferred brand name drugs.
Generic or Generic Drug – Medications with the same active ingredient(s) as their brand-name counterparts that are equal in dosage, safety, strength, quality, performance and use.
Generic Substitution – The administration of a drug product with the same ingredient(s) in place of a brand name drug.
Help Desk – Integrated call centers with highly trained customer service representatives providing service and attention to member and client needs.
HIPAA – Health Insurance Portability and Accountability Act. A notice of privacy practice that describes how LDI may use and disclose PHI (protected health information) to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law.
Infusion Services – See Home Infusion Therapy
Mail Order Services – Provides prescribed medications to participants, via U.S. mail or UPS, and is usually more cost effective when used for long-term maintenance medications.
Maintenance Medication or Long Term Maintenance Medications – Medications that are prescribed to treat long term conditions, such as high blood pressure or diabetes.
Non-Participating LDI network pharmacy – A pharmacy that is not within LDI’s network of retail pharmacies. Participants using a non-participating pharmacy will pay full price for their prescriptions.
Outpatient Services – A patient who receives therapy in a hospital or clinical setting.
Pharmacy Benefit Manager (PBM) – An organization that manages the pharmaceuticals benefit for the payer. A PBM provides many services designed to lower pharmaceutical costs for their clients, including: DUR, claims processing, retail pharmacy networks, formulary programs, mail service programs, physician profiling and education.
Pre-Certification – see Prior Authorization.
Retail Pharmacy Network – Retail pharmacies that have been contracted with a pharmacy benefit manager.
RxPortal – A secure, online benefit service for members, allowing them to access information about their prescription drug benefits, locate a pharmacy nearest to them, order prescription refills online, retrieve co-pay estimates, view claim history and retrieve brand and generic drug information.
Short-term Medications – Medications used to treat acute medical conditions, such as the common cold.
Specialty Medication – High-cost, injectable, oral, infused or inhaled medications that are either self-administered or administered by a healthcare provider, and used or obtained in either an outpatient or home setting.
Specialty Pharmacy Services – Services designed to provide bio-injectable, oral, infused or inhaled medications to individuals with chronic diseases and conditions.
Step Therapy – A program designed to work with physicians to consider all of the medications available to treat a disease or condition, taking into consideration medications that are well-established, safe, and cost effective.
Therapeutic Substitution – The dispensing of a drug, when prescribed by a physician, that belongs to the same drug class and works in the body similar to the original drug requested. The drug dispensed is listed on the plan’s formulary and may be brand name or generic and is often less expensive than the original drug requested.
Turnaround Time – Refers to the amount of time it takes to fill an order for a prescription medication and then mail the medication after LDI has received the prescription.