Executive summary. Reimbursement terms each describe a different part of how a pharmacy claim is priced and paid.
Definition
Pharmacy reimbursement is the payment a pharmacy receives for a covered prescription after the plan’s pricing rules are applied.
Where this work lives in Attergo
Margin workspaces, payer scorecards, remittances, and underpayment cases in Attergo put a payer result next to the contract and the claim that produced it. Keep the payer response and the team’s follow-up on one record, and a recurring question becomes visible instead of repeating quietly.
Dispensing fee, usual and customary price, acquisition cost, MAC, AWP, and NADAC each mean something specific. Interpret any of them against the contract, payer policy, or official reference that governs the claim in front of you.
Review and follow up
Build a shared glossary for staff using the exact language from the relevant agreement. When a payment question comes up, preserve the claim response and the version of the pricing material used to review it.
Final decisions stay with the role your organization holds accountable for them. Record the decision on the item, with the evidence behind it, so the next person to open it does not start over.
Frequently asked questions
Who should use this Attergo workspace?
The role that owns the next action leads it: a billing specialist, an authorization coordinator, an inventory lead, a pharmacist, a compliance lead, or a finance reviewer. Access follows the role your organization assigns.
Referenced standards and further reading
- CMS: National Average Drug Acquisition Cost ↗Centers for Medicare & Medicaid Services
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