CPhT Insurance and Billing Flashcards
6 cards from real CPHT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CPhT Insurance and Billing flashcards as text
What does 'DAW' stand for on a prescription?
Answer: Dispense As Written
DAW (Dispense As Written) indicates the prescriber requires the brand-name drug and no generic substitution is allowed.
What is a pharmacy benefit manager (PBM)?
Answer: A third-party administrator that manages prescription drug benefits
A PBM is a third-party administrator that manages prescription drug benefits on behalf of health insurers, employers, and other payers.
What is a formulary?
Answer: A list of approved medications covered by an insurance plan
A formulary is a list of prescription drugs covered by a health insurance plan, typically organized into tiers based on cost.
What does 'prior authorization' (PA) require?
Answer: Approval from the insurance company before dispensing certain medications
Prior authorization requires the prescriber to obtain approval from the insurance company before a specific medication will be covered.
What is a copayment in pharmacy billing?
Answer: A fixed amount the patient pays for a prescription
A copayment is a fixed dollar amount the patient pays out-of-pocket for each prescription at the time of dispensing.
What is the BIN number used for in pharmacy?
Answer: Routing insurance claims to the correct PBM
The BIN (Bank Identification Number) is a 6-digit number on insurance cards used to route electronic prescription claims to the correct PBM.