Pharmaceutical Industry Acronyms Defined

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

Have you ever tried to read a piece of literature, only to learn that you were unfamiliar with many of the terms within? Although you may have an idea of what you are reading, it can be difficult to fully grasp all concepts when you are unclear about terms and phrases that are used over and over again.

Specifically focusing on the pharmaceutical industry and the nature of our work, we at PBIRx realize how complex it can be for current clients, prospective clients and those simply seeking information about what we do to understand the texts they come across. With so many variations of different laws and guidelines, and a multitude of acronyms used to define benefit plans, treatments and more, there is so much that needs to be learned before one can become truly familiar with all that they see and read.

To help clear up any confusion, we have outlined a few of the most common acronyms our team uses along with their definitions:

CMS: CMS refers to the Centers for Medicare and Medicaid Services. To learn more about this government agency and its role in health care, click here.

CTIRx: This term is especially important for our clients to know! CTIRx (Clinical Technology Intelligence) is one of our own proprietary offerings with over 100 clinical algorithms used with our client’s actual utilization to identify programs resulting in significant savings. It is a division of PBIRx that works to recommend clinical cost savings opportunities and facilitate program implementations with doctors and members. We also measure the actual savings as compared to estimated savings provided to our clients.

HIPAA: HIPAA is an acronym for the Health Insurance Portability and Accountability Act of 1996. This act is voluminous and provides protection to American workers including:

• Limited exclusions for medical conditions that already exist.
• Offering new rights that permit individuals to receive health coverage in various situations, such as when they get married or lose previous coverage.
• Prohibiting discrimination in terms of both enrollment and cost based on factors pertaining to health-status.
• Major restrictions on the protection of Patient Health Information (PHI)

But that is not all! Learn more here.

OTC: OTC stands for over the counter, meaning you are not required to provide a prescription to buy the medicine. Some examples of over the counter medicines (or non prescription medicines) are Advil, Claritin and Tylenol. 

PMPM: PMPM is the acronym for per member per month. Typically looked at and determined on a monthly basis, this refers to the ratio of service or cost for the number of employees in a group.

If you are in charge of your company's benefits, these terms are extremely important to know as they will likely be mentioned in various conversations and within several documents that you receive. But should there be other terms that you are still unsure about, we want to define them for you right away! To have your questions answered, be sure to visit us on Facebook or Twitter to let us know what still needs to be clarified.

Here at PBIRx, we are dedicated to making sure that our clients are familiar with the information they are presented every step of the way. For more information about our services and how we can help you next with the management of your pharmacy benefit plan, please give us a call at (888) 797-2479.