What is the process of adjudication in pharmacy?

Adjudication in pharmacy refers specifically to the process of sending a prescription claim to a patient's insurance provider for approval and payment. This step is crucial in determining how much of the medication cost will be covered by the insurance and what the patient’s out-of-pocket expenses will be. During adjudication, the insurance will verify the patient's coverage, check for any restrictions or necessary prior authorizations, and then either approve or deny the claim based on the patient's plan.

This process helps ensure that both the pharmacy and the patient understand their financial responsibilities regarding the medication. Overall, it's a key part of prescription processing that facilitates efficient reimbursement for the pharmacy while providing clarity to patients about their medication costs. This understanding of adjudication sets it apart from other pharmacy functions, such as handling patient inquiries or managing inventory, which do not directly involve the insurance claims process.