| MMA Glossary: Acronyms and Definitions |
|
|
|
 |
| A-C |
|
AAA-Area Agency on Aging
ADAP-AIDs Drugs Assistance Program
Auto-enrollment-In October 2005, CMS randomly assigns dual eligible individuals into Prescription Drug Plans (PDPs).
Biological- Usually a drug or vaccine made from a live product and used medically to diagnose, prevent, or treat a medical condition (e.g. flu or pneumonia shot).
BOB-Benzodiazepines, OTC drugs, Barbiturates
Catastrophic Coverage-The highest amount of money paid out-of-pocket before a health plan pays the majority or all copay amounts. Medicare Part D catastrophic coverage begins at $3,600 out-of-pocket and $5,100 in total drug costs (total drug costs include what the beneficiary and other payers have paid).
Clawback-The calculated amount that the state government pays the federal government to provide the Medicare Part D drug benefit beginning January 1, 2006.
CMS-Centers for Medicare and Medicaid Services
Coinsurance-A fixed percentage paid per prescription per fill.
Compound Drugs-Two or more drugs added together by a pharmacy.
Copayment (copay)-A fixed amount paid per prescription per fill.
Cost-sharing Tier-Different levels of copay amounts depending on the type of drug. The lowest copay is for generics, followed by formulary brands, and a non-formulary copay is in the highest tier.
Creditable Coverage-Creditable coverage means an insurance policy that is as good or better than a Part D plan. (e.g. retiree drug coverage).
|
|
|
| D-G |
|
DD-Developmentally Disabled
Deemed-Any individual considered automatically eligible for extra help with the Medicare Part D drug benefit (this includes individuals with Medicaid, a Medicare Savings Program, or SSI).
DHS-Department of Human Services
Dual Eligible-A person who has Medicare and Medicaid
EOPC-Eastern Oregon Psychiatric Center
EOTC-Eastern Oregon Training Center
FCHP-Fully Capitated Health Plan (These are the Medicare Managed Care organizations that provide health coverage for OHP clients).
Formulary-A formulary is a list of drugs that a health plan will cover. Formulary drugs usually have lower copays than non-formulary drugs. A formulary is also known as a Preferred Drug List.
FPL-Federal Poverty Level
|
|
|
| H-N |
|
LIS-Low Income Subsidy. The LIS program is operated by SSA and provides extra help with prescription drug costs for individuals who meet the income and asset requirements.
LTC-Long Term Care
MA-Medicare Advantage plans (currently known as Medicare Managed Care organizations, they replace Medicare +Choice plans).
MA-PD-Medicare Advantage Prescription Drug plan
Medigap-A supplemental insurance policy provided by a private insurance company designed to provide coverage for medical care not covered by Medicare (some policies have a limited drug benefit).
MMA-Medicare Modernization and Prescription Drug Act
MSA-Medical Savings Accounts
MSP-Medicare Savings Program (these assist with paying for Medicare Part A and/or B costs).
|
|
|
| O-R |
|
OMAP-Office of Medical Assistance Programs
OMHAS-Office of Mental Health and Addiction Services
OTC-Over-the-Counter drugs
OSH-Oregon State Hospital
PA-Prior Authorization
PACE-Program for the All-inclusive Care of the Elderly (this is an acute LTC provider that is also fully capitated).
Partial Dual Eligible-Medicare beneficiaries (QMB, SLMB, QI 1) with Medicare premiums and/or deductibles paid for by Medicaid, however, there is no actual Medicaid coverage provided.
PBM-Pharmacy Benefits Manager
PDL-Preferred Drug List (also known as a formulary)
PDP-Prescription Drug Plan
QI-1-Qualified Individual (Medicare Savings Program)
QMB-Qualified Medicare Beneficiary (Medicare Savings Program).
Quantity Limit-A limit placed on the quantity of a medication covered by an insurance company.
|
|
|
| S-Z |
|
Self-Administer-Medicare considers a drug to be self-administered when patients are administering the drug more than 50% of the time.
SLMB-Specified Low-Income Medicare Beneficiary (Medicare Savings Program).
SNP-Special Needs Plan (an FCHP that serves primarily institutionalized clients and those with Medicaid).
SPA-State Plan Amendment
SPAP-State Pharmaceutical Assistance Program (Oregon does not have an SPAP).
SPD-Seniors and People with Disabilities
SSA-Social Security Administration
Step Therapy-Trial of an alternative drug before coverage is provided for the originally prescribed drug.
TrOOP-True Out-of-Pocket costs
|
|
|
|
