#1
What is the primary function of healthcare insurance?
To cover the cost of medical expenses
ExplanationFinancial coverage for medical costs.
#2
Which of the following is a typical feature of pharmacy benefits management (PBM)?
Prescription drug coverage
ExplanationManagement of prescription drug benefits.
#3
Which federal agency oversees Medicare Part D, the prescription drug benefit program?
Centers for Medicare & Medicaid Services (CMS)
ExplanationRegulator of Medicare prescription benefits.
#4
What is the role of a pharmacy benefit manager (PBM) in the healthcare insurance industry?
To administer prescription drug benefits on behalf of insurers
ExplanationManagement of drug benefits for insurers.
#5
Which type of pharmacy is often used to fulfill mail-order prescriptions in pharmacy benefits management?
Mail-order pharmacy
ExplanationPharmacy for mail-delivered prescriptions.
#6
What does the term 'formulary' refer to in the context of healthcare insurance?
A list of covered medications
ExplanationList of medications covered by insurance.
#7
Which entity typically negotiates drug prices with pharmaceutical companies on behalf of healthcare insurance providers?
Pharmacy Benefits Manager (PBM)
ExplanationNegotiator of drug prices for insurers.
#8
What is a prior authorization requirement in pharmacy benefits management?
A restriction on certain medications requiring approval before coverage
ExplanationMandate for approval before coverage.
#9
Which of the following is a potential advantage of pharmacy benefits management for healthcare insurers?
Improved medication adherence among patients
ExplanationEnhanced patient adherence to medications.
#10
What is a drug formulary exception process in pharmacy benefits management?
A mechanism for patients to appeal coverage decisions for specific drugs
ExplanationProcess for appealing drug coverage.
#11
What is meant by the term 'tiered formulary' in pharmacy benefits management?
A formulary that categorizes drugs into different cost levels
ExplanationClassification of drugs by cost tiers.
#12
What is a common method used by pharmacy benefit managers (PBMs) to control medication costs?
Implementing step therapy programs
ExplanationEnforcing a step-by-step medication approach.
#13
In the context of pharmacy benefits management, what does the term 'rebate' typically refer to?
A payment made by pharmaceutical companies to PBMs
ExplanationPayment from drug manufacturers to PBMs.
#14
What is the purpose of utilization management in pharmacy benefits management?
To ensure appropriate and cost-effective use of medications
ExplanationEnsuring proper medication utilization.
#15
What is a common strategy employed by pharmacy benefit managers (PBMs) to manage drug costs?
Negotiating lower drug prices with manufacturers
ExplanationSecuring lower drug costs from manufacturers.