CSP Intake and Patient Onboarding 2

Question 1

A specialty pharmacy receives an e-prescription for a limited distribution drug (LDD) that the pharmacy is not in the manufacturer's network to dispense. What is the most appropriate intake action?

Accepted Answer

Transfer the prescription to an in-network specialty pharmacy and notify the prescriber and patient

Answer

LDDs can only be dispensed by pharmacies in the manufacturer's network, so prompt transfer with notification prevents delays in therapy.

Question 2

During a benefits investigation, the intake team learns a self-administered specialty drug is covered under the patient's medical benefit rather than the pharmacy benefit. What does this primarily affect?

Accepted Answer

How the claim is billed and which authorization process applies

Answer

Medical versus pharmacy benefit coverage determines the billing pathway (e.g., J-code/CMS-1500 vs. NCPDP) and the payer's prior authorization requirements.

Question 3

A commercially insured patient cannot afford a $3,000 specialty copay. Which resource is typically the first option to check for this patient?

Accepted Answer

Manufacturer copay assistance card

Answer

Manufacturer copay cards are generally available to commercially insured patients and can sharply reduce out-of-pocket costs.

Question 4

Why are manufacturer copay coupons generally prohibited for patients enrolled in Medicare Part D?

Accepted Answer

They may violate the federal Anti-Kickback Statute

Answer

The OIG considers manufacturer copay assistance for federal health program beneficiaries a potential inducement under the Anti-Kickback Statute.

Question 5

Which item is typically NOT required on a complete specialty pharmacy referral intake form?

Accepted Answer

The patient's preferred grocery store

Answer

A complete referral needs clinical, prescriber, and insurance data, but unrelated personal preferences are not required.

CSP - Certified Specialty Pharmacist Practice Test

CSP - Certified Specialty Pharmacist Practice Test

CSP Intake and Patient Onboarding 2