Managed Care & Reimbursement Flashcards
7 cards from real CNPR practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Managed Care & Reimbursement flashcards as text
A High Deductible Health Plan (HDHP) is often paired with which savings vehicle?
Answer: Health Savings Account (HSA)
HDHPs are designed to be paired with Health Savings Accounts (HSAs), which allow employees to save pre-tax dollars to pay for qualified medical expenses including prescription drugs.
Wholesale Acquisition Cost (WAC) is best described as:
Answer: The manufacturer's list price for a drug sold to wholesalers or direct purchasers
WAC is the manufacturer's published list price for a drug at the first point of sale (to wholesalers or direct purchasers), before any discounts or rebates are applied.
Co-insurance differs from a co-pay in that co-insurance is:
Answer: A percentage of the drug's cost shared between the patient and the insurer
Co-insurance is a percentage of the drug's total cost (e.g., 20%) that the patient pays, meaning the patient's expense varies based on the drug's price, unlike a flat co-pay.
Group Purchasing Organizations (GPOs) primarily help hospitals and health systems by:
Answer: Negotiating contracts and pricing with manufacturers to leverage collective buying power
GPOs aggregate the purchasing power of multiple hospitals and health systems to negotiate lower prices and better contract terms with drug manufacturers and distributors.
Patient Assistance Programs (PAPs) offered by pharmaceutical manufacturers are intended to:
Answer: Help uninsured or underinsured patients access medications they cannot otherwise afford
PAPs provide free or low-cost medications to eligible patients who are uninsured, underinsured, or otherwise unable to afford their prescribed treatments, improving access and adherence.
A formulary exception allows a patient to:
Answer: Request coverage of a non-formulary drug when medically necessary, subject to plan review
A formulary exception (or coverage exception) allows a patient or prescriber to request coverage for a drug not on the formulary by demonstrating medical necessity or that formulary alternatives are clinically inappropriate.
A pharmaceutical sales representative's primary goal when working with managed care accounts is to:
Answer: Secure favorable formulary placement to improve patient and prescriber access to their product
A key managed care objective for pharma reps is to achieve favorable formulary tier status (preferred placement) so that more patients can access the drug at lower cost with fewer access barriers.