PBM Glossary Terms D
Appro-Rx helps improve the way pharmacy benefits management is done every day to help lower prescription costs. However, we understand that the world of PBMs can be confusing. Below we have answered your most frequently asked questions to give you a better understanding of your needs!
Day Treatment Center
An outpatient psychiatric facility that is licensed to provide outpatient care and treatment of mental and nervous disorders or substance abuse under the supervision of physicians.
Deductible
An amount that a Member must pay for Covered Services in a specified time period in accordance with the Member's Plan before the Plan will pay benefits.
Dependent
A person who is eligible to be enrolled for coverage by the subscriber as determined by the employer and agreed upon with the plan. Examples would be a subscriber's spouse or child.
Diagnostic Tests
Tests and procedures ordered by a provider to determine if a patient has a specific condition or disease based upon specific signs or symptoms demonstrated by the patient. Such diagnostic tools include, but are not limited to, radiology, ultrasound, nuclear medicine, and laboratory and pathology services or tests.
Drug Formulary
A listing of prescription drugs established by the health plan, which includes both Brand Name Prescription Drugs, and Generic Prescription Drugs. This list is subject to periodic review and modification by the health plan.
Durable Medical Equipment (DME)
Equipment which is a) made for and mainly used in the treatment of a disease or injury; b) made to withstand prolonged use; c) suited for use while not confined as an inpatient in the Hospital; d) not normally of use to persons who do not have a disease or 1injury; e) not for use in altering air quality or temperature; and f) not for exercise or training.
