Terminology

340B – The 340B Drug Price Program is federal program in the United States that enables eligible healthcare organizations to purchase outpatient drugs at significantly reduced prices.

AAC – Average Acquisition Cost, refers to the average price that pharmacies pay to acquire a drug, which includes the cost of the drug itself, along with any additional expenses such as shipping and handling.

ACA – Affordable Care Act. Purpose: Enacted in 2010, the ACA aimed to increase the quality and affordability of health insurance, reduce the number of uninsured individuals, and improve healthcare outcomes. Expanded Medicaid eligibility to include more low-income individuals and families in participating states.

ADAP – Aids Drug Assistance Program, helps provide medications for individuals living with HIV/AIDS.

AMP – Average Manufacturer Price. It is a pricing metric used in the pharmaceutical industry to determine the average price that manufacturers receive for their drugs, excluding certain discounts and rebates.

ANFAMP – Annual NFAMP

ASP – Average Sales Price. The average price that manufacturers receive for their drugs sold in the U.S., calculated based on sales data after accounting for discounts, rebates, and other pricing adjustments.

AWP – Average Wholesale Price, is a benchmark used to estimate the average price at which wholesalers sell a drug to retailers or pharmacies. It represents a theoretical average based on reported prices from manufacturers.

BAMP – Base AMP, this is usually the first published AMP which is used for the baseline of calculating inflation penalty within Federal URA calculation.

BCPIU – Baseline CPIU, used for the baseline in inflation penalty calculation for federal URA.

BOQ – Beginning of Quarter

BP – Best Price, refers to the lowest price that a manufacturer offers for a drug to any purchaser, including wholesalers, retailers, and other entities, excluding certain discounts and rebates.

CART – Chimeric Antigen Receptor T-cell Therapy. CART therapy involves modifying a patient’s own T cells (a type of white blood cell) to express chimeric antigen receptors (CARs) that can recognize and attack cancer cells.

CHIP – Children’s Health Insurance Program: provides health coverage for children in families with incomes too high to qualify for Medicaid but too low to afford private coverage.

CLD – Claim Level Detail. Provides detailed information about individual claims submitted to Medicaid for reimbursement. It includes specific data elements related to the services provided, the provider, and the patient.

CMS – Centers for Medicare & Medicaid Services, it is a federal agency within the U.S. Department of Health and Human Services (HHS) responsible for administering the nation’s major healthcare programs.

CPIU – Consumer Price Index for All Urban Consumers, measures the average change over time in the prices paid by urban consumers for a market basket of consumer goods and services.

DRA – Deficit Reduction Act (DRA) of 2005. Purpose: The DRA was enacted to address the federal budget deficit by making various changes to entitlement programs, including Medicaid and Medicare.

DUR – Drug Utilization Review – a report that is a component of the Centers for Medicare & Medicaid Services’ efforts to ensure the safe and effective use of medications among beneficiaries. It typically involves analyzing prescription drug use to identify potential issues

EOQ – End of Quarter

FCP – Federal Ceiling Price, the maximum price that the U.S. government will pay for a drug purchased under certain federal programs, specifically for the Department of Veterans Affairs (VA), the Department of Defense (DoD), and other federal agencies.

FFSU – Fee for Service Utilization, Units, a utlization type for a Medicaid Claim Line

GNUP – Guaranteed Net Unit Price

GP – Government Pricing

HCPCS – Healthcare Common Procedure Coding System. HCPCS is a set of codes used to represent medical procedures, services, and supplies in healthcare billing and documentation.

IRA – Inflation Reduction Act, aims to reduce federal spending on prescription drug costs through methods such as price caps and inflation rebates.

JCODE – Medicaid programs use J-Codes to determine the reimbursement rate for the administered drugs. This may be based on factors like the drug’s average wholesale price (AWP) or other pricing benchmarks.

JW – The JW modifier is used to identify the amount of a drug that is discarded or wasted and cannot be reused. It specifically applies to drugs that are administered in a way that leaves a portion unused.

MAMP – Monthly AMP

MCD – Medicaid

MCOU – Managed Care Organization Utilization, a utlization type for a Medicaid Claim Line

NADAC – Natitional Average Drug Acquisition Cost, it is a pricing benchmark used in Medicaid to determine the average cost of drugs acquired by retail pharmacies.

NCPDP – National Council for Prescription Drug Programs (NCPDP) is a nonprofit organization that develops and promotes standards for electronic healthcare transactions, particularly those related to pharmacy services.

NDC – National Drug Code

NDC11 – 11 Digit National Drug Code – identifier for a drug

NDC9 – 9 Digit National Drug Code – identifier for a drug, less granular than an NDC11

NFAMP – National Average Manufacturer Price. It is a measure used primarily for calculating the average manufacturer prices of drugs across the United States.

NPI – National Provider Identifier. The NPI is a unique identification number assigned to healthcare providers in the United States. It is used in administrative and financial transactions, including billing and claims processing.

OIG – Office of Inspector General, which is a division of a federal or state agency that is responsible for preventing unlawful or inefficient operations

PHE – Public Health Emergency

PHS (Price) – PHS Price is the ceiling price that the U.S. Department of Health and Human Services (HHS) sets for certain drugs purchased through the Public Health Service. It is intended to ensure that government programs can access medications at affordable rates.

QAMP – Quarterly AMP

QNFAMP – Quarterly NFAMP

RCP – Retail Community Pharmacy Ratio

RPU – Rebate Per Unit, analagous to a URA

RX – Prescription

SPAP – State Pharmaceutical Assistance Program

SRA – Supplemental Rebate Agreement, is a contract that provides for additional rebates from drug manufacturers on top of the mandatory federal rebates already in place for Medicaid-covered drugs.

UOM – Unit of Measure, indicates how a medication or substance is measured, such as milligrams (mg), milliliters (mL), tablets, or capsules.

UPPS – Units Per Package Size required for standardizing units

URA – Unit Rebate Amount, standard metric of a Medicaid rebate to be applied to an Medicaid Claim Line

VA – Department of Veterans Affairs

VBA – Value-Based Agreement is a contract or agreement between Medicaid programs and healthcare providers that ties reimbursement to the quality of care and patient outcomes rather than the volume of services provided.

WAC – Wholesaler Acquisition Cost, it is the manufacturer’s list price for a drug when sold to wholesalers or direct purchasers.