Using standards created by NCPDP, a prescriber is able to electronically send an accurate, error-free, and understandable prescription directly to a pharmacy from the point of care, which is an important element in improving the quality of patient care. ERx replaces a handwritten, verbal, or faxed prescription.

EPCS establishes the standards authorizing a prescriber to electronically transmit prescriptions for controlled substances (e.g., opioids or high abuse potential) directly to a pharmacy from the point of care. CMS mandates the use of EPCS, and the Drug Enforcement Agency (DEA) has requirements for provider and pharmacy systems.

Electronic Prior Authorization (ePA) is the electronic transmission of information between the prescriber and health plan sponsor to determine whether the prior authorization on a prescription is granted by the sponsor. The National Council for Prescription Drug Programs (NCPDP) has developed technical standards to support this electronic transmission and improve the timeliness of the exchange of information.

ERISA is the federal law governing employee health benefit plans, which also applies to employer-provided health insurance. The U.S. Department of Labor (DOL) defines “ERISA” as “a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.” First enacted in 1974, federal ERISA law is the result of plan sponsors, including businesses and unions, seeking to have a uniform standard of benefits for their employees across state lines. To achieve this goal, ERISA includes a robust preemption provision that prevents states from imposing a patchwork of conflicting state laws. Many health plans organized under ERISA are self-insured/self-funded, meaning that the plan sponsor, rather than a third party, bears the risk of coverage. This is distinct from fully insured plan sponsors, who purchase third-party health insurance to establish coverage and hold the ultimate risk.

A person enrolled in and covered by a health plan sponsor, also known as a member. Under Medicare, eligible individuals are generally referred to as beneficiaries, but once they enroll in a plan, they are considered enrollees in that plan.

When the original patent applicable to the active compound of a brand-name drug is due to expire, drug manufacturers often claim large numbers of complex and often highly speculative patents. This typically involves filing for new patents on secondary features of the product or on ancillary changes to the product formulation to artificially extend the term of patent protection.

A document provided by the health plan sponsor that helps a person understand the total charges for a health care service or product, such as a prescription drug, the amount negotiated by a plan sponsor or its delegated PBM, how much the health plan sponsor will cover, and how much the patient should expect to pay.