CNPR Managed Care & Reimbursement 3

Question 1

A High Deductible Health Plan (HDHP) is often paired with which savings vehicle?

Accepted Answer

Health Savings Account (HSA)

Answer

Flexible Spending Account (FSA) only

Answer

401(k) retirement account

Answer

Health Reimbursement Arrangement (HRA) only

Question 2

Wholesale Acquisition Cost (WAC) is best described as:

Accepted Answer

The manufacturer's list price for a drug sold to wholesalers or direct purchasers

Answer

The final price paid by patients after insurance adjustment

Answer

The reimbursement rate set by CMS for Medicare Part D drugs

Answer

The discounted price negotiated between a hospital and a GPO

Question 3

Co-insurance differs from a co-pay in that co-insurance is:

Accepted Answer

A percentage of the drug's cost shared between the patient and the insurer

Answer

A fixed dollar amount paid per prescription regardless of drug cost

Answer

A penalty charged for using out-of-network providers

Answer

A separate premium payment made monthly by the patient

Question 4

Group Purchasing Organizations (GPOs) primarily help hospitals and health systems by:

Accepted Answer

Negotiating contracts and pricing with manufacturers to leverage collective buying power

Answer

Providing direct patient care services in underserved communities

Answer

Conducting clinical trials for experimental pharmaceuticals

Answer

Auditing pharmaceutical sales representatives for compliance

Question 5

Patient Assistance Programs (PAPs) offered by pharmaceutical manufacturers are intended to:

Accepted Answer

Help uninsured or underinsured patients access medications they cannot otherwise afford

Answer

Provide rebates to pharmacy benefit managers for formulary placement

Answer

Train pharmaceutical sales representatives on clinical knowledge

Answer

Subsidize the cost of clinical trials for FDA approval

Question 6

A formulary exception allows a patient to:

Accepted Answer

Request coverage of a non-formulary drug when medically necessary, subject to plan review

Answer

Automatically receive all Tier 1 generics without a co-pay

Answer

Bypass the formulary process entirely and purchase drugs at AWP

Answer

Switch their PBM without approval from their employer

Question 7

A pharmaceutical sales representative's primary goal when working with managed care accounts is to:

Accepted Answer

Secure favorable formulary placement to improve patient and prescriber access to their product

Answer

Convince payers to eliminate generic substitution policies

Answer

Negotiate directly with individual patients to lower their out-of-pocket costs

Answer

File prior authorization requests on behalf of prescribers