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The Pharmacy Technician Chapter 14

Terms

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The Maximum Allowable Cost is usually (greater than or less than) the Usual and Customary (U&C) price.
less than
What is meant by Maximum Allowable Cost or MAC?
the maximum price per tablet (or other dispensing unit) an insurer or PBM will pay for a given product
What is meant by U&C or UCR?
the maximum amount of payment for a given prescription, determined by the insurer to be a usual and customary (and reasonable) price
What does the DAW code 0 indicate?
No DAW
What does the DAW code 1 indicate?
DAW handwritten on the prescription by the prescriber
What does the DAW code 2 indicate?
Patient requested brand
What does the DAW code 3 indicate?
Pharmacist selected brand
What does the DAW code 4 indicate?
Generic not in stock
What does the DAW code 5 indicate?
Brand name dispensed but priced as generic
What does the DAW code 6 indicate?
N/A
What does the DAW code 7 indicate?
Substitution not allowed; brand mandated by law
What does the DAW code 8 indicate?
Generic not available
What does it mean when "Refills Not Covered" is the reason for a rejected claim?
The patient has a mail order pharmacy for maintenance medications.

Deck Info

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