D. Price Code File
The Price Code File
Price Codes allow pharmacies to automatically adjust prescription pricing by applying dispensing fees, markups, minimum pricing rules, and cost calculations based on the medication's cost. Because pricing scenarios can vary significantly, contact Support if you need assistance building or troubleshooting a specific pricing schedule.
To access the Drug Price Schedule File screen, click on File D. Price Code File.
Adding a New Price Code
Select Add New Schedule, enter a Price Schedule Code, choose a Drug Price Level (typically AWP), and set the Drug Cost Factor. Optionally enable rounding and set a Minimum Total to prevent the final price from falling below a specified amount.
Price Code Name: Unique name used to identify the price code and its pricing schedule.
Drug Price Level: Determines the pricing source used as the starting point for calculations. Available options include:
AWP – Uses the drug's Average Wholesale Price.
Direct Price – Uses the Direct Price stored in the drug file.
Fed Mac – Uses the Federal MAC price stored in the drug file.
Acq Cost – Uses the drug's Acquisition Cost.
Custom Dispense Price – Uses the Custom Dispense Price configured in the drug file.
AWP + Per Unit Markup – Uses AWP plus an additional amount per dispensed unit.
Direct Price + Per Unit Markup – Uses Direct Price plus an additional amount per dispensed unit.
Fed Mac + Per Unit Markup – Uses Fed Mac plus an additional amount per dispensed unit.
Acq Cost + Per Unit Markup – Uses Acquisition Cost plus an additional amount per dispensed unit.
Custom Dispense Price + Per Unit Markup – Uses Custom Dispense Price plus an additional amount per dispensed unit.
AWP + Flat Markup – Uses AWP plus a fixed dollar amount.
Direct Price + Flat Markup – Uses Direct Price plus a fixed dollar amount.
Fed Mac + Flat Markup – Uses Fed Mac plus a fixed dollar amount.
Acq Cost + Flat Markup – Uses Acquisition Cost plus a fixed dollar amount.
Custom Dispense Price + Flat Markup – Uses Custom Dispense Price plus a fixed dollar amount.
Drug Cost Factor: Percentage applied to the selected Drug Price Level before additional fees or markups are calculated. A value of 100% uses the full price, while other percentages increase or decrease the calculated cost.
For Cash Rxs, Round Up to Next: Determines how cash prescription totals are rounded after pricing is calculated.
Don't Round – No rounding is applied.
.5 – Rounds up to the next value ending in .50.
.9 – Rounds up to the next value ending in .90.
.0 – Rounds up to the next whole dollar.
.95 – Rounds up to the next value ending in .95.
.99 – Rounds up to the next value ending in .99.
.00 – Rounds up to the next whole dollar amount.
Minimum Total: Sets the lowest amount the prescription can be priced at after all calculations. If the calculated total falls below this value, the Minimum Total is used instead.
Enter the Max Cost, Dispensing Fee, and Markup % for each pricing tier, then click Save. The system automatically calculates the Min Cost for each range.
How Price Codes Calculate Pricing
The system calculates the prescription's base cost using the selected Drug Price Level and Drug Cost Factor. It then applies any dispensing fee and markup associated with the matching cost range to determine the final price.
Example
A prescription with a $100 base cost falls within the $0–$100 pricing tier. If that tier includes a $10 dispensing fee and a 15% markup, the system adds $25 in fees and markup to the $100 base cost, resulting in a final price of $125.
Editing an Existing Price Code
Select the price code, make the necessary changes, and click Save. To save the changes and return to the Rx Processing screen, click Save & Exit.
Deleting a Price Code
Select Edit Schedule, open the desired price code, click Delete, and confirm the deletion when prompted. Use Cancel to clear the screen without making changes.
Price Code in Rx Processing
In the Rx Processing screen, select the desired price code from the Price Code drop-down menu to apply a pricing schedule created in the Price Code File.
Common Price Code Issues & Resolutions
Price Code Not Applying or Total Not Changing
Issue
A price code is created or updated, but the prescription total does not change.
Common Causes
The Rx was created before the price code was added or modified.
BestRx has not refreshed the updated price code.
A different price code is being applied during processing.
Resolution
Confirm the correct price code is displayed on the Rx Processing screen.
Test the change on a new Rx.
Restart BestRx if the price code was recently added or modified.
Insurance Plan Price Code Overriding Drug File Price Code
Issue
The expected drug file price code is not being used during processing.
Common Causes
An insurance plan has its own assigned price code.
The insurance plan price code is overriding the drug file price code.
Resolution
Review the insurance plan pricing setup.
Verify whether a price code is assigned at the insurance plan level.
Update or remove the insurance plan price code as needed.
Cash or Charge Account Using the Wrong Price Code
Issue
Cash or charge account prescriptions calculate using unexpected pricing.
Common Causes
Incorrect price code assigned to the cash plan.
Incorrect price code assigned to the charge account insurance plan.
Pricing is being pulled from a different plan configuration.
Resolution
Review the cash plan setup.
Review the charge account insurance file.
Assign the desired price code directly within the applicable plan.
Compound Pricing Not Calculating Correctly
Issue
Price codes appear correct, but compound prescriptions calculate incorrectly.
Common Causes
Insurance setup calculates from the sum of ingredients.
Pricing is not being pulled from the drug file.
Resolution
Review insurance pricing settings.
Verify whether calculations use ingredient costs or drug file pricing.
Adjust the calculation method if necessary.
Wrong Price Code Being Selected
Issue
A different price code is automatically selected during processing.
Common Causes
Conflicting insurance plan settings.
Legacy pricing configurations.
Previous fill information affecting current processing.
Resolution
Verify the selected price code on the Rx Processing screen.
Review insurance, cash plan, and drug file assignments.
Confirm the assigned price code exists and is active.