This glossary covers the core vocabulary for the Order Entry and Processing domain, which makes up about 22.5% of the scored PTCE. This domain focuses on the operational and technical side of moving a prescription from intake to the patient.
- Adjudication
- The process by which a third-party payer (such as an insurance plan) reviews and responds to a submitted prescription claim, determining whether it will be paid, rejected, or requires further action.
- AWP (Average Wholesale Price)
- A benchmark price used in the pharmaceutical industry, often as a reference point for calculating drug reimbursement, though it does not necessarily reflect the actual price paid by a pharmacy.
- Bin Number
- A number found on a patient's insurance card that identifies the specific processor or payer system used to route a pharmacy claim electronically.
- Compounding
- The process of combining, mixing, or altering ingredients to create a customized medication for an individual patient's needs, performed under a pharmacist's supervision.
- Copay
- The fixed dollar amount a patient is required to pay out of pocket for a prescription under their insurance plan.
- Coinsurance
- The percentage of a prescription's cost that a patient is responsible for paying after any deductible has been met, as opposed to a fixed copay amount.
- Day Supply
- The number of days a prescribed quantity of medication is expected to last a patient, calculated based on the dose and dosing frequency.
- DAW (Dispense As Written)
- A code entered on a prescription claim indicating whether a brand-name drug must be dispensed as written or whether a generic substitution is permitted.
- Deductible
- The amount a patient must pay out of pocket for covered services or prescriptions before their insurance plan begins to pay.
- DUR (Drug Utilization Review)
- A review process, often built into pharmacy software, that evaluates a prescription for issues such as drug interactions, therapeutic duplication, incorrect dosing, or allergy conflicts before it is dispensed.
- Extemporaneous Compounding
- The preparation of a customized medication at the time it is needed, based on a specific prescription, rather than in advance or in bulk.
- Extraction Ratio
- A calculation used in compounding to determine the amount of active drug that can be recovered from a commercially available dosage form for use in a compounded preparation.
- Formulary
- A list of prescription drugs, both generic and brand name, that are approved for coverage by a specific health insurance plan.
- Group Number
- A number on a patient's insurance card that identifies the specific employer or organization group associated with their health plan, used during claim adjudication.
- Inventory Turnover
- A measure of how many times a pharmacy's stock of a drug is sold and replaced over a given period, used to help manage purchasing and reduce waste.
- Lot Number
- A unique identifier assigned by the manufacturer to a specific batch of a drug product, used for tracking, recalls, and quality control.
- National Drug Code (NDC)
- A unique, FDA-assigned numeric identifier for a specific drug product, including its manufacturer, product, and package size, used for billing, inventory, and identification.
- Order Entry
- The process of entering a prescription or medication order into the pharmacy computer system, including patient, drug, and prescriber information.
- Original Prescription (or "Hard Copy")
- The physical or original electronic record of a prescription as written by the prescriber, retained by the pharmacy for recordkeeping purposes.
- OTC (Over-the-Counter)
- A drug product that does not require a prescription and can be purchased directly by a consumer.
- PA (Prior Authorization)
- A requirement from an insurance plan that a prescriber obtain approval before a specific medication will be covered, often used for high-cost or non-formulary drugs.
- Par Level
- The minimum quantity of a particular drug or supply that a pharmacy aims to keep in stock at all times, used to trigger reordering.
- PBM (Pharmacy Benefit Manager)
- A third-party company that administers prescription drug benefits on behalf of health insurers, employers, and government programs, including processing claims and managing formularies.
- Perpetual Inventory
- An inventory tracking system, often required for controlled substances, that continuously updates stock counts in real time as products are received and dispensed.
- Point of Sale (POS)
- The system used at checkout to process a customer's payment and complete a transaction, including prescription pickups.
- Prescription Label
- The printed label affixed to a dispensed medication container that includes information such as the patient's name, drug name, strength, directions for use, and prescription number.
- PCN (Processor Control Number)
- A secondary identifier found on an insurance card, used alongside the BIN number, to help route a pharmacy claim to the correct plan for adjudication.
- Reconstitution
- The process of adding a diluent, such as sterile water, to a powdered medication to prepare it in liquid form for dispensing or administration.
- Refill
- An additional dispensing of a medication under an existing prescription, authorized by the original prescriber up to a specified number of times.
- Reimbursement
- The payment a pharmacy receives from a third-party payer for a dispensed prescription claim.
- Repackaging
- The process of transferring a drug from its original manufacturer container into a different container, such as a unit-dose package, for dispensing purposes.
- Rejected Claim
- A prescription claim that is denied by the third-party payer during adjudication, often due to issues such as prior authorization requirements, refill-too-soon edits, or coverage exclusions.
- Sig (Signa)
- The portion of a prescription that provides the directions for use, telling the patient how to take the medication.
- Specific Gravity
- A calculation used in pharmacy compounding that compares the density of a liquid ingredient to the density of water, used to convert between weight and volume measurements.
- Third-Party Payer
- An entity, such as an insurance company or government program, that pays for all or part of a patient's prescription cost on their behalf.
- Titration
- The gradual adjustment of a medication's dose, typically increased or decreased over time, to reach an optimal therapeutic effect while minimizing side effects.
- Triturate
- To grind a substance, such as a tablet, into a fine powder as part of the compounding process.
- Unit Dose
- A packaging system in which a single dose of medication is individually packaged and labeled, commonly used in institutional pharmacy settings.
- Volume of Distribution
- A pharmacokinetic value that describes the extent to which a drug distributes into body tissue relative to the blood plasma concentration.
- Wholesaler
- A company that purchases drug products from manufacturers in bulk and distributes them to pharmacies.