Resource Library
The State and Federal Program Source Map for Access & Reimbursement Professionals
Official sources. Practical organization. Compliance-first use.
Drug Pricing & Reimbursement Glossary
Need to clarify a reimbursement term quickly? Search PharmaARMs’ plain-language glossary of drug pricing, coverage, Medicare, Medicaid, coding, pharmacy operations, and access terminology.
Access & Reimbursement Source Map
Use This Page When You Need to Verify
Start here when you need to locate official sources, reimbursement reference points, federal program information, or access-related policy resources before taking next steps.
Medicare Coverage Pathways
Review coverage pathways, NCDs, LCDs, MAC guidance, and Medicare policy references.
Part B vs. Part D Considerations
Clarify whether a therapy may involve medical benefit, pharmacy benefit, or plan-specific review.
HCPCS, ASP, OPPS & Fee Schedule References
Locate coding, payment, ASP pricing, OPPS addenda, and fee schedule reference materials.
Medicare Advantage & Part D Plan Resources
Review plan-level resources, formularies, coverage determinations, and appeal pathways.
Medicaid & State-Level Program Information
Access state Medicaid profiles, program information, and state-specific coverage considerations.
340B Covered Entity Information
Verify 340B program participation, covered entity status, eligibility, and related HRSA resources.
TRICARE, FEHB, VA & IHS Pharmacy Resources
Review federal health plan and government pharmacy resources for benefit and formulary questions.
FDA Labeling, REMS, NDC, Orange Book & Purple Book
Find product labeling, REMS requirements, NDC information, drug approval, and biologic references.
HIPAA, OIG, Open Payments & Exclusion Resources
Access privacy, compliance, transparency, fraud and abuse, and exclusion-list resources.
Provider Enrollment, NPI & MAC Contractor Information
Look up provider enrollment resources, NPI records, PECOS information, and MAC contractor details.
Legal Principles & Oversight Map
Federal Oversight of Key Compliance Areas
| Legal Principle | Primary Oversight Agency(ies) | What They Oversee |
|---|---|---|
|
1
Patient Safety
|
Drug approval, safety monitoring, manufacturing quality, and adverse event reporting. | |
|
2
Regulatory Compliance
|
Compliance with approved labeling, promotion, manufacturing, and post-market requirements. | |
|
3
Truthful & Non-Misleading Communications
|
Prescription drug promotion, advertising, and marketing claims. | |
|
4
Anti-Kickback & Improper Inducements
|
Enforcement of the Anti-Kickback Statute, False Claims Act, and fraud investigations. | |
|
5
Patient Privacy & Confidentiality
|
Enforcement of privacy and security requirements under HIPAA. | |
|
6
Fair Competition (Antitrust)
|
Anti-competitive conduct, mergers, monopolization, and collusion. | |
|
7
Transparency (Payments to HCPs)
|
Administration of the Open Payments Program, also known as the Sunshine Act. | |
|
8
Product Quality & Manufacturing
|
Good Manufacturing Practice, inspections, recalls, and quality systems. | |
|
9
Accurate Documentation & Recordkeeping
|
Data integrity, documentation accuracy, and records supporting regulatory compliance. | |
|
10
Government Program Integrity
|
Medicare/Medicaid billing, reimbursement, fraud, waste, abuse, and False Claims Act enforcement. | |
|
11
Ethical Promotion
|
Promotional activities consistent with FDA-approved labeling and regulations. | |
|
12
Adverse Event & Product Complaint Reporting
|
Pharmacovigilance, post-marketing surveillance, and product safety reporting. | |
|
13
Corporate Integrity & Ethical Conduct
|
Corporate Integrity Agreements, compliance programs, and enforcement actions. |
Access & Reimbursement Source Navigator
Find authoritative resources for coverage research, reimbursement, coding, Medicare, Medicaid, federal programs, drug information, compliance, and professional reference needs. Open a category below to explore its official source links.
Medicare Coverage & Payment Tools
Official federal resources for Medicare coverage research, local and national coverage determinations, MAC guidance, claims review, coding, and payment reference points.
CMS Medicare Coverage Database
Search NCDs, LCDs, billing and coding articles, CPT/HCPCS, and ICD-10 references.
Open official resource →Local Coverage Determinations
Understand how Medicare contractors define local coverage and related documentation requirements.
Open official resource →Medicare Administrative Contractors
Identify the appropriate MAC by state or jurisdiction and access official contractor portals.
Open official resource →Physician Fee Schedule Lookup
Look up Medicare PFS payment rates, RVUs, locality, and HCPCS/CPT reimbursement references.
Open official resource →Part B Drug ASP Pricing Files
Review CMS quarterly ASP pricing files for Medicare Part B drugs.
Open official resource →HCPCS Level II Coding
Review CMS HCPCS Level II coding information and quarterly updates.
Open official resource →Hospital OPPS Addenda
Check OPPS Addendum A/B status indicators, APC groups, and outpatient payment rates.
Open official resource →Medicare FFS Appeals / Redetermination
Find first-level Medicare appeal and redetermination information.
Open official resource →Medicare Secondary Payer
Understand when Medicare is secondary and where coordination-of-benefits issues may arise.
Open official resource →CMS Prior Authorization & Pre-Claim Review
Track Medicare FFS prior authorization and pre-claim review initiatives.
Open official resource →Medicare Part D & Affordability Resources
Official resources for prescription drug coverage, formularies, coverage determinations, redeterminations, Extra Help, and Medicare Prescription Payment Plan education.
Medicare Part D Overview
Understand the Medicare prescription drug benefit and Part D plan structure.
Open official resource →CMS Part D Formulary Guidance
Review prescription drug coverage policies and formulary framework.
Open official resource →Medicare Plan Compare
Compare Medicare health and drug plans by ZIP code.
Open official resource →Medicare Prescription Payment Plan
Review CMS guidance on spreading Part D out-of-pocket prescription costs through capped monthly payments.
Open official resource →Part D Coverage Determinations
Understand Part D coverage determination and exception processes.
Open official resource →Part D Redeterminations
Review timing and process for redetermination requests after an adverse coverage determination.
Open official resource →SSA Extra Help
Direct users to official Extra Help information for Medicare prescription drug costs.
Open official resource →Medicaid, CHIP & 340B Resources
Official resources for state Medicaid profiles, Medicaid and CHIP information, 340B program participation, covered entity lookup, and income-based eligibility references.
Medicaid State Profiles
Review state Medicaid and CHIP profiles.
Open official resource →Medicaid State Overviews
Access federal Medicaid and CHIP program summaries and transparency resources.
Open official resource →340B Drug Pricing Program
Review HRSA’s official 340B program information.
Open official resource →340B OPAIS
Search covered entities, contract pharmacies, and manufacturers.
Open official resource →340B Covered Entity Search
Verify covered entity participation in the 340B program.
Open official resource →340B Eligibility & Registration
Review covered entity eligibility and registration information.
Open official resource →HHS Poverty Guidelines
Use for income-based program context and affordability-resource references.
Open official resource →Federal Health Plan & Government Pharmacy Resources
Official resources for TRICARE, FEHB, VA, and Indian Health Service pharmacy and formulary research.
TRICARE Pharmacy Program
Review TRICARE prescription drug coverage and pharmacy program information.
Open official resource →TRICARE Prior Authorization / Medical Necessity
Find TRICARE pharmacy prior authorization and medical-necessity form guidance.
Open official resource →OPM FEHB Plan Compare
Compare FEHB plans and verify that brochures remain the official benefit source.
Open official resource →OPM FEHB Plan Brochures
Access FEHB plan brochures and carrier information by state.
Open official resource →VA Formulary Advisor
Search VA National Formulary and Criteria for Use documents.
Open official resource →IHS National Core Formulary
Review Indian Health Service National Core Formulary information.
Open official resource →FDA Product, Labeling & Safety Resources
Official FDA and federal resources for approved labeling, NDC information, REMS, biologics and biosimilars, clinical trials, MedWatch, and drug shortages.
FDA Drug Approvals & Databases
Central FDA hub for drug databases, labeling, NDC, Orange Book, and related tools.
Open official resource →Orange Book
Verify FDA-approved small-molecule drug products, therapeutic equivalence, patents, and exclusivity.
Open official resource →Purple Book
Verify FDA-licensed biological products, biosimilars, interchangeables, and reference products.
Open official resource →NDC Directory
Search active and certified drug NDC information submitted to FDA.
Open official resource →FDA REMS
Review REMS requirements for medications with serious safety concerns.
Open official resource →FDA REMS Public Dashboard
Explore REMS data and public reports.
Open official resource →FDA MedWatch
Report or review information about serious medical product problems and safety alerts.
Open official resource →ClinicalTrials.gov
Search clinical studies, trial records, and available study results.
Open official resource →FDA Drug Shortages
Check current FDA drug shortage information.
Open official resource →Compliance, Privacy & Transparency Resources
Official federal resources for HIPAA, OIG compliance guidance, fraud and abuse alerts, exclusion screening, and Open Payments transparency research.
HHS HIPAA Privacy Rule
Review federal privacy standards for PHI and covered entities.
Open official resource →HHS HIPAA for Professionals
Access HHS/OCR HIPAA professional guidance and education resources.
Open official resource →OIG Compliance Guidance
Review OIG compliance program guidance and risk-area resources.
Open official resource →OIG Special Fraud Alerts & Bulletins
Track fraud and abuse guidance, including pharmaceutical manufacturer copay and related risk areas.
Open official resource →OIG LEIE Exclusions Search
Search excluded individuals and entities.
Open official resource →Open Payments
Search CMS Open Payments data for payments to physicians, APPs, and teaching hospitals.
Open official resource →Provider Verification & Enrollment Resources
Official resources for provider identification, NPI lookup, Medicare enrollment, PECOS research, and provider/supplier enrollment status checks.
NPPES NPI Registry
Look up active NPI records for providers and organizations.
Open official resource →PECOS
Access Medicare provider enrollment, chain, and ownership information.
Open official resource →Medicare Provider Enrollment
Review provider and supplier Medicare enrollment resources.
Open official resource →PECOS Application Status
Check Medicare provider or supplier enrollment application status.
Open official resource →