Diagnosis-related group categories that are used by hospital facilities on discharge billing.

Computer software program that assigns diagnosis-related groups (DRGs) by abstracting data (i.e., patient’s age, sex, principal diagnosis, principal procedures performed, and discharge status) to assign appropriate DRGs to discharged patients.

Reimbursement amount a hospital receives for a Medicare patient who is assigned to a diagnosis-related group (DRG) that considers the wage rates in the hospital’s region and the cost related to the DRG.

Index number that reflects the resource spending associated with each diagnosis-related group.

Insurance underwriting phrase for evidence of alcohol abuse or alcoholism.

List of prescribed drugs recommended by a managed care plan and dispensed by participating pharmacies to members of the plan. It is periodically reviewed and modified. See the three types—open, closed, and restricted formularies for information. See formulary .
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A schedule of prescription drugs approved for use which will be covered by the Health Insurance Plan of the insurer and dispensed through participating pharmacies.

Weekly update of drug prices at average wholesale price (AWP) that is from the American Druggist Blue Book . See maximum allowable cost list .

Entity licensed to dispense prescription drugs such as pharmacy (pharmacist), physician, or other licensed health care professional.

Option introduced in the Medicare prescription drug plan that allows each plan to group different drug types together (i.e., generic, brand, preferred brand). Tiers could be used to describe drug groups that are based on classes of drugs. If the tier option is used, the plan should provide clarification on the drug types covered under the tier in the prescription drug plan notes section.