pharmacy benefit manager (PBM)

Company under contract with managed care organizations, self-insured companies, and government programs to manage pharmacy network management, drug utilization review, outcomes management, and disease management. The goal is to save money. For example, a pharmacy benefit manager may fill drug prescriptions by mail order as part of a corporate health insurance plan. Also called a pharmacy benefit management organization or prescription benefit manager (PBM).

Pharmacy claim

Formal request for payment (bill) generated because of an insured’s purchase of prescription drugs dispensed by a pharmacist from a physician’s written instructions (prescription form).

Phishing

Practice of masquerading as a legitimate company to con consumers into willingly giving up their personal information such as an e-mail stating that information must be resubmitted because records were lost or an account needs to be verified.
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The fraudulent practice of sending emails purporting to be from reputable companies in order to induce individuals to reveal personal information, such as passwords and credit card numbers.

PHO

Abbreviation for physician hospital organization. See medical staff-hospital organization and physician hospital organization (PHO).