When this screen appears, please keep the following points in mind:
- If adjudicating to any payor, there is not be a price difference in the ingredient cost. If there is, please check if there is a generic alternative, if the days supply is limited to 30 days, if the price of the medication is correct (check the ABC website). If the mark up cost contains no diffence, then a small difference (10-20% cost of ingredient) is allowed in the ingredient cost.
- for any payor other than ODB/TR, a difference in the mark up should be waived as long as the difference is 10-20% of the ingredient cost (#1).
- NIHB will only pay the ODB price for the ingredient cost and mark up so expect this differnce. These amounts should be waived.
- Please remember to waive all $2.00 copay for ODB/TR
- If there is a diffenrence in the dispensing fee, reduce the copay by $1 (this matches the $9.99 fee we charge for cash paying patients) (#3)
- Please make sure to check the previously charged amount for all refills
- It is always a good idea to review the Gross Profit (#4). This will give you an idea if things went through correctly. If there is a negative number, ask the pharmacist to review.
- In the above case, if there is no secondary payor, the software will tell you how much to charge (#3). Make sure to waive the markup difference (see above notes)