Mar 31 2010
CompPharma (www.comppharma.com), a consortium of workers' compensation pharmacy benefit managers (PBMs), has compiled a directory of terms and definitions describing various aspects of the workers' compensation pharmacy industry. "CompPharmaPedia," is available at www.comppharma.com/glossary.html.
“Payers need to be able to compare apples to apples”
The initiative was undertaken to give industry stakeholders insight into the specialized language of workers' compensation pharmacy. "We thought it would be particularly useful to public policy makers as they work through legislation and regulation to address the myriad issues surrounding work comp pharmacy, most notably the demise of the Average Wholesale Price (AWP) benchmark," said Joseph Paduda, president of CompPharma. It may also be a useful reference for payers, employers, reporters, and health care providers.
The resource offers standard definitions for terms that can mean different things to different organizations. For example, "cost per script" can refer to a medication or to a 30-day supply of that medication or the paper on which the prescription is written. CompPharma's standardized directory defines it as "the average cost per prescription dispensed and reimbursed, normalized to a thirty (30) day supply."
Paduda noted that the tool will also be useful for payers as they review different PBM programs and proposals. "Payers need to be able to compare apples to apples," he said.
A seemingly simple term like "savings" is an easily confused concept. CompPharmaPedia defines savings as "the difference between the amount paid below the fee schedule and the fee schedule, calculated either as a dollar amount or a percentage below fee schedule. In those states without a fee schedule, the basis is usual and customary."
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