CompPharma LLC, a consortium of workers comp PBMs, has just published a glossary of terms commonly used in the comp pharmacy business, the press release is here and the glossary, which entitled CompPharmaPedia, is here.
Why a glossary?
Several reasons.
Regulators and legislators are working feverishly to figure out what they will use as a basis for their pharmacy fee schedules when AWP is no longer published by First DataBank. While they are working on fees, they may well want to tweak other provisions of the comp code; CompPharmaPedia can help provide a standard definition of terms so stakeholders have a consistent understanding of what, for example, a ‘claim’ is.
(in comp, a claim is the injury and all the activity surrounding that activity; in group and governmental programs a claim is the bill for a specific medical procedure(s) or prescription or service)
Many payers are looking to improve the results of their pharmacy programs, and there’s a good deal of confusion out there as different PBMs use different definitions in their reports and marketing literature. CompPharmaPedia is an attempt at standardization, so payers can do the proverbial “apples to apples” comparison.
Researchers are looking deeper into comp pharmacy, and CompPharmaPedia should help them use standardized terms to improve understanding across the entire community.
A couple of disclaimers.
CompPharmaPedia is a service; there is no ‘requirement’ that PBMs, or anyone else, use the definitions. PBMs may and some likely will continue to use their own definitions.
CompPharmaPedia is also a work-in-progress, and will evolve as the comp pharmacy business does. Expect more terms to be added and current definitions to be ‘tweaked’.
(Note – CompPharma is owned by myself and Helen Knight.)
Apr
9
