CVS CVS Assessment Insurance and Prescription Processing Questions and Answers

Question 1

What information is typically required to process a prescription through insurance at CVS?

Accepted Answer

BIN, PCN, group number, and member ID from the insurance card

Answer

The BIN, PCN, group number, and member ID are the four fields the pharmacy system needs to submit a claim to the insurer.

Question 2

A claim is rejected with the message 'refill too soon.' This most commonly means:

Accepted Answer

The insurance will not pay because the previous fill has not run out yet based on days-supply calculations

Answer

Insurers track days-supply to enforce fill intervals and will reject early refills until a set percentage of the prior supply is used.

Question 3

When a drug is rejected as 'non-formulary,' the best next step is to:

Accepted Answer

Notify the pharmacist, who may contact the prescriber about a formulary alternative or prior authorization

Answer

Non-formulary rejections require clinical intervention—either a therapeutic substitution authorized by the prescriber or a prior authorization.

Question 4

What is a 'prior authorization' (PA) in the context of prescription insurance?

Accepted Answer

A process where the insurer requires medical justification before approving coverage for a drug

Answer

A PA requires the prescriber to submit clinical evidence to the insurer proving the drug is medically necessary.

Question 5

If a patient wants to pay cash instead of using insurance for a prescription, what should the technician do?

Accepted Answer

Process it as a cash transaction at the applicable price and inform the patient of any discount programs

Answer

Patients have the right to pay out-of-pocket; technicians should process the cash transaction and mention programs like CVS discount pricing.

CVS - Assessment Practice Test