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

An HMO requires members to select a primary care physician (PCP) and obtain referrals to see specialists, and generally limits coverage to providers within the plan's network.

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

AWP is a published benchmark price for prescription drugs used as a reference point in pricing negotiations and reimbursement calculations, though it does not reflect actual transaction prices.

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

Generic substitution allows pharmacists to dispense an AB-rated (therapeutically equivalent) generic version of a brand-name drug, which has the same active ingredient, dosage form, and strength.

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 is a federal health insurance program primarily for people 65 and older or those with qualifying disabilities, while Medicaid is a joint state-federal program for individuals with low income.

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

Specialty pharmacies handle complex, high-cost drugs such as biologics, injectables, and specialty medications that require special storage, handling, patient education, and adherence monitoring.

(CNPR) Certified National Pharmaceutical Representative Practice Test

(CNPR) Certified National Pharmaceutical Representative Practice Test

CNPR Managed Care & Reimbursement 2