Free 5-question sample test with instant feedback. See how ready you are.
Question 1
What term describes any payer other than the patient who reimburses a pharmacy for prescription costs?
Answer: A third-party payer. This includes insurance companies, government programs (Medicare, Medicaid), and pharmacy benefit managers (PBMs).
Question 2
What is a Pharmacy Benefit Manager (PBM)?
Answer: A PBM is an intermediary company that manages prescription drug benefits on behalf of insurers, employers, or government programs, and negotiates drug pricing and formularies.
Question 3
Which federal program provides prescription drug coverage through Medicare Part D?
Answer: Medicare Part D is a voluntary federal program that provides outpatient prescription drug coverage to Medicare-eligible individuals through private insurance plans.
Question 4
What is a formulary in the context of pharmacy insurance?
Answer: A formulary is a list of prescription drugs covered by an insurance plan, often organized by tiers that determine the patient's co-pay amount.
Question 5
What is the standard electronic format used to submit pharmacy claims to insurance companies?
Answer: The NCPDP (National Council for Prescription Drug Programs) D.0 transaction standard is used to electronically transmit pharmacy claims to payers.