Price Table Logic

Price Tables are used to set up the formula the system uses to calculate an item's price. PrimeCare uses spreadsheet pricing which contains conditions and formulas:

Conditions are the specified criteria that must be met before the corresponding formula is applied

The functionality of a price table is based on 'if.....then....' logic. The conditions are the 'if' part of the statement; the formulas are the 'then' part of the statement. For example, if the drug class is 2, then add an additional $2.00 fee.

Conditions are the criteria that must be met before the corresponding formula is applied.

Condition Variable	Definition
MCDCST	Medicaid price per unit from Drug Record
MISC1	Miscellaneous 1 price per unit from Drug Record
MISC2	Miscellaneous 2 price per unit from Drug Record
AWP	Average wholesale price per unit from Drug Record
ACQ	Acquisition price per unit from Drug Record
COST	Rx Cost (defaults to AWP)
FEE	Dispensing fee
DISCOUNT	Discount Amount
PRICE	Total price to charge (including markup and fee)
COPAY	Copay amount
EXTRA	Any additional charge specified when filling a prescription
QTY	Dispensing quantity
DAYSUPPLY	Days supply of the prescription
AGE	Patient's age
CLASS	Drug class (2 - 6 is Class 2 - 6. SO is OTC.)
PKSZ	Drug package size
GENERIC	Drug Generic Indicator (G = Generic, M = Multi-Source, S = Single-Source)
INDYTD	Individual year-to-date paid by patient
INDBEN	Individual benefit paid by Third Party/Medicaid
INDRX	Total number of prescriptions filled for a patient
FAMYTD	Year-to-date paid by a family
FAMBEN	Family benefit paid by Third Party/Medicaid
FAMRX	Total number of prescriptions filled for this individual's family
ALTCOST	Cost of brand (used with percent of brand pricing)
ALTFEE	Fee of brand (used with percent of brand pricing
ALTPRICE	Price of brand (used with percent of brand pricing)
HASBRAND	Y/N field. Y = generic drug has a valid brand drug. N = there is not a brand in the system for the generic.
PAID	Paid is a patient insurance amount. The paid figure is the deductible amount paid by the patient.
Formula Variable	Definition
COST	Rx cost (defaults to AWP)
FEE	Dispensing Fee
DISCOUNT	Discount Amount
PRICE	Total price to charge (including markup and fee)
COPAY	Copay amount
EXTRA	Any additional charge specified when filling a prescription

The system begins at the first row (001) and checks conditions (multiple conditions can be entered on a row). If all conditions are met, the system exits the table. If conditions are not met, the system automatically proceeds to the next row (002) to check conditions. This process can continue for several rows.

Each piece of data within a Condition or Formula is stored in a cell. A cell may contain one of the following:

Compare Operators: Compare operators are used with Conditions to narrow down specified criteria. Valid compare operators:

Arithmetic Operators: Arithmetic operators are used with Formulas to perform the pricing calculations. Valid arithmetic operators:

GO Command: The GO Command specifies a row to process. Typically, the system automatically exits the Price Table once the conditions are met on a level. If there are no conditions, the row is processed and then the system moves to the next level. However, to skip a level, use the GO Command to proceed directly to the specified level. For example, GO 3 means go to Row 3.