One of the most important features in QuickSCRIP is the ability to set dynamic pricing systems for specific drugs, insurance companies, and customers. Pricing tables are used to determine your Cash prices and your Usual and Customary values for electronic insurance claims.
QuickSCRIP has an internal hierarchy to determine what price table is applied in what circumstances. If you think QuickSCRIP is miscalculating a price value for a prescription, we recommend checking these locations to make sure one price table isn't overriding another.
- Drug (Drug File Maintenance, line 5). QuickSCRIP defaults to this price table if no other table can be applied to a scrip.
- Insurance (Insurance Vendor File Maintenance, lines 21 and 22). Sets Usual and Customary values for insurances. If there is no table present here, QuickSCRIP defaults to the table attached to the drug.
- Customer (Patient File Maintenance, line 73) allows you to setup custom pricing for specific customers. If there is no table present here, then QuickSCRIP defaults to the Insurance table, then to Drug table.
Please Note While a price table will impact what Usual and Customary Value is transmitted to an insurance company, it does not impact how much that insurance company will reimburse for a claim. Read transmission responses carefully, a most will state how much was reimbursed and what the pricing basis of reimbursement was (COST, MAC, WAC, ect).
Price Table File Maintenance
The Price Table File Maintenance Screen allows you to view, create, and edit price tables.
- Start in the Rx Processing Menu
- Choose Option 15 Price Table File Main.
- Once in the Price Table Screen, there are some options available to the user:
- E will exit back to the Processing Menu or previous screen. (F12 functions the same way)
- F allows you to search for a price table by number. (F4 functions the same way)
- A allows you to add a new price table. (F7' functions the same way).
Alternatively, F10 from the Customer, Drug, Or Insurance Vendor File Maintenance Screens will take you to the Price Table Screen. This will also automatically display the price table associated with the drug, customer, or insurance vendor.
Once you have searched for a price table, we will populate the screen with relevant data.
- Price Table Number displays the assigned number for a price table. This must be a unique number, and can be up to three digits long.
- Description allows the user to enter a description of the table. Descriptions like "Cash Pricing", "Medicare Table", or "Vaccines" are useful to let you know what the table is intended for.
- The 'To' Column (Leftmost column) allows you to set cutoff points for a set value. (Line 123 allows you to set what type of value).
- The '%' Column (Center column) allows you to add or subtract from the price by a positive or negative percent value.
- The Fee Column (Rightmost column) lets you add or subtract a flat dollar value to the price.
- Line 123 Type lets you set what type of cutoff value is used on the 'To' column:
- D for Dollars sets the breakpoints as dollar value of the drug's cost (can be ACQ of AWP).
- Q for Quantity sets the breakpoints as quantity of the drug.
- P for Per Pill Pricing sets the breakpoints at the quantity of the drug, but multiplies instead of adds the 'Fee' column value. This is ideal for situations when you which to base your fee on the number of individual pills dispensed.
- S for Days Supply lets you set breakpoints for days supply of a scrip.
- Line 124 OverCost allows you to set the basis of price for D type price tables.
- A translates to AWP Average Wholesale Price
- D translates to DIR Direct Price
- Q translates to ACQ Acquisition Cost
- M translates to MAC Maximum Allowable Cost
- W translates to WAC Wholesale Acquisition Cost
- 3 translates to 340B special 340B pricing for applicable dispensaries.
- Line 125 Gx Table will jump to this table if the drug is generic. Allows you to link Brand and Generic Tables together.
- Line 126 Flag allows you to set special exemption cases to a price table:
- F Only adds the Dispensing Fee (column 3) to New scrips.
- 4 Use 4 decimal places in the fee field for a 'P' Pill table. Example 13.33 would convert to 0.1333 in the table calculation.
Special Price Tables
Line 123 of the Price Table Screen can allow you to designate a price table to be used in very specialized circumstances.
- R will designate the table as a Rounding Table. This table would be used to round upward or downward to dollar or coin denominations. Ideally used for cash claims. This is set in the Business Control File, Screen 3, Line 15. Price table 75 is designated as the QuickSCRIP default rounding table.
- I will designate the table as a Discount table and can only be used to create customer discounts (Business Control File, Screen 3)
- C will designate an Insurance Copay Table can can only be used to calculate insurance copay values (Ins Vendor File, screen 2, line 23). This can be used for customers whose copay amount is set as a percent or flat value. This isn't used as often, as insurances will set the copay in the response to an electronic claim.
- A will designate a Price Adjustment Table for adjusting retail pricing.
QuickSCRIP can run a variety of reports to give an idea of what price tables are in your system, or what drugs may be linked to a particular table.
Print All Price Tables
This report prints a flat list of every table by number, along with descriptions, and column values.
- Start in the Pharmacy Main Menu
- Choose Option 4 Reports
- Choose Option 9 Pricing Tables
- Enter Y to print report.
Print Drugs by Price Table
This report will print a list of drugs linked to a particular price table. This can be useful for catching any drugs that may be attached to old price tables you no longer wish to use.
- Start in the Pharmacy Main Menu
- Choose Option 4 Reports
- Choose Option 2 Drug Reports
- Choose Option 1 Drug by Name or NDC
- On lines 1 and 2, enter the Name Range to search for (commonly the first alphabetical drug on line 1 and "ZZZZZZZZZZZZZZZ" on line 2).
- On line 5 Switches add a /T will prompt you for a specific price table.
- P will then print the report to your designated report printer.