CNPR Managed Care & Reimbursement 2

Question 1

Which managed care plan type restricts members to a network of providers and requires referrals to see specialists?

Accepted Answer

Health Maintenance Organization (HMO)

Answer

Preferred Provider Organization (PPO)

Answer

High Deductible Health Plan (HDHP)

Answer

Point of Service (POS) plan

Question 2

AWP (Average Wholesale Price) in the pharmaceutical industry refers to:

Accepted Answer

A benchmark price published for prescription drugs, often used in pricing and reimbursement calculations

Answer

The price the government mandates for all wholesale drug transactions

Answer

The average price consumers pay at retail pharmacies without insurance

Answer

The price set by the FDA for new drug approvals

Question 3

Generic substitution allows a pharmacist to:

Accepted Answer

Dispense a therapeutically equivalent generic drug in place of a prescribed brand-name drug

Answer

Substitute a brand-name drug with a therapeutic alternative from a different drug class

Answer

Substitute one controlled substance for another with the prescriber's written consent

Answer

Replace a patient's medication with an OTC equivalent without physician approval

Question 4

What is the primary difference between Medicare and Medicaid?

Accepted Answer

Medicare is age/disability-based federal insurance; Medicaid is income-based state-federal insurance

Answer

Medicare covers prescription drugs only; Medicaid covers medical services only

Answer

Medicare is administered by states; Medicaid is administered by the federal government

Answer

Medicare applies only to veterans; Medicaid applies to all citizens

Question 5

Specialty pharmacies are most commonly used for drugs that:

Accepted Answer

Are complex, high-cost biologics or specialty medications requiring special handling and monitoring

Answer

Are available over the counter and require no prescription

Answer

Are inexpensive generics dispensed in 90-day supplies

Answer

Are first-line antibiotics prescribed for common infections

Question 6

Drug Utilization Review (DUR) is a program used by payers to:

Accepted Answer

Review prescribing patterns to identify safety issues, inappropriate use, or cost savings opportunities

Answer

Evaluate the commercial viability of new pharmaceutical products before launch

Answer

Audit pharmaceutical sales representatives' call activity

Answer

Assess clinical trial data submitted for FDA approval

Question 7

In managed care, rebates are typically paid by drug manufacturers to:

Accepted Answer

Pharmacy Benefit Managers or health plans in exchange for favorable formulary placement

Answer

Patients to reduce out-of-pocket costs at the pharmacy counter

Answer

The FDA as a fee for expedited drug review

Answer

Prescribers to incentivize higher prescribing volume