The retail price charged by a pharmacy for a drug without the use of insurance. Also known as the “cash price.”

Utilization management is a set of programs adopted by a health plan sponsor to help ensure appropriate use of health care services and medications. In the pharmacy benefit, a PBM administers the plan’s UM program. These programs promote safe, appropriate use of medications, and reduce the likelihood of prescription drug waste. Utilization management includes prior authorization (PA), step therapy, drug utilization review (DUR), refill-too-soon edits, and quantity limits .