SET 4
Companies that administer drug benefit programs are called
Pharmacy benefit manager's
Another party, besides the patient or pharmacy, that pay some or all of the cost of the medication is
Third party payer
What is the meaning of a AAC?
Actual acquisition cost
What is the meaning of AWP?
Average wholesale price
Which of the following acronyms refers to the price a pharmacy pays for a drug after receiving discounts and rebates?
AAC
Which of the following acronyms is associated with reimbursement of generic medications?
MAC
What is a third-party payment?
Reimbursement to the pharmacy for prescription services
Which term refers to the processing of a prescription claim to a third-party provider?
Online adjudication
Generic drugs are usually in tier
One
Which of the following is not an advantage of standardized prescription card format?
Increased calls to the help desk
Which of the following terms refers to a member or recipient in managed care organizations?
Subscriber
The prescription drug co-pay is paid by
The patient
What type of co-payment is a different dollar amount based on the type of drug being dispensed?
Verifiable co-pay
Plans in which the patient pays a different co-pay amount depending on whether a generic or brand name is this dispensed have
Dual co-pays
The rules for coordination of benefits ensure that the benefit coverage for a claim does not exceed of the total cost.
100%
What does U & C mean when billing prescriptions?
Usual and customary
Which of the following is the basic formula for determining the price of a prescription being filled?
Cost plus dispensing fee
What term refers to the amount of money a patient must pay in a given period before the third- party insurer will make a payment?
Deductible
Coordination of benefits occurs when there are
Two different health insurance plans that provide coverage for the same prescription
A pharmacy tech is asked to" COB" a claim. What does "COB" mean?
Coordination of benefits
A is a network of providers for which costs are covered inside, but not outside of the network.
HMO
Which of the following terms refers to the cost of health insurance?
Premium
Which of the following managed-care organizations provide patients with the least restrictions and therefore higher premiums and out-of-pocket expenses?
Preferred provider organization's
Which type of managed-care program is least likely to require generic substitution?
PPO
A husband and wife both have insurance through their employer's for themselves and each other. The insurance that should be considered primary for each is the one that
Is in their own name
Medicare part D covers
Prescription medications
Medicare is administered by