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Pharmacy Management Final Exam (Non-Cumulative) || Already Graded A+.

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Third-party payers that interact directly with retail pharmacies include: correct answers - Pharmacy benefit managers - Medicare prescription drug plans - Medicare advantage plans with prescription drug benefits - Medicaid Which are mechanisms used by third-party payers to control prescriptio...

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Publié le 10 septembre 2024
Nombre de pages 9
Écrit en 2024/2025
Type Examen
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third party payers that interact directly with ret

Établissement Pharmacy Management
Cours Pharmacy Management

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Pharmacy Management Final Exam (Non-Cumulative) ||
Already Graded A+.
Third-party payers that interact directly with retail pharmacies include: correct answers -
Pharmacy benefit managers
- Medicare prescription drug plans
- Medicare advantage plans with prescription drug benefits
- Medicaid

Which are mechanisms used by third-party payers to control prescription costs and control
utilization? correct answers - Prior authorization
- Step therapy
- Generic substitution
- Quantity limits
- Formularies

Define formulary correct answers List of medications covered by an insurer

What describes the "prior authorization" programs? correct answers - Allow access to certain
medications to patients who meet specified criteria
- Prescribers must get approval from the plan before patients can receive medications subject to
prior approval requirements

Dispensing fees refer to _____. correct answers Fees paid to the retail pharmacy to cover the
operational cost of dispensing.

A rebate is _____. correct answers The discount received by a pharmacy benefit manager (PBM)
from a pharmaceutical manufacturer for placing a drug on the PBM's formulary or giving it
preferred status designation.

In the current retail pharmacy reimbursement framework, ______. correct answers Most third-
party payers pay for prescriptions on a retrospective, fee-for-service basis.

What is it called when a patient must pay for a specified amount of charges per coverage period
before the prescription benefits start to cover expenses? correct answers Deductible

Chain, independent, and mail-order pharmacies purchase prescription medications from
wholesalers or pharmaceutical manufacturers and file claims with third-party payers to receive
payments for prescriptions when dispensed. For which patients does this apply? correct answers
For all patients when they get their prescriptions filled.

The cost of dispensing medication in a retail pharmacy is often less than the dispensing fee paid
by a third-party payer. Where does the money come from to pay for the cost of dispensing?
correct answers Pharmacies take some of the profit made from the medication to cover
dispensing costs.

, There is one independently owned pharmacy in Anytown and nearly 100% of the pharmacy's
customers are employees of the automobile manufacturer. The automobile manufacturer is
changing health carriers to reduce pharmacy-related health care costs for its employees. The new
insurance carrier for the automobile manufacturer offers a plan that will lower the gross margin
percentage for prescriptions from 24% to 17%. What would change in the accounting
statements? correct answers - The retained earnings section will be affected by the reduced net
income at the end of the accounting period.
- The income statement will show the direct effect of the change in reimbursement due to the
change in insurance carriers

There is one independently owned pharmacy in Anytown and nearly 100% of the pharmacy's
customers are employees of the automobile manufacturer. The pharmacy has annual prescription
sales of $4,000,000 and employs two full-time pharmacists and three full-time technicians. The
building has no mortgage, and there is only a small over-the-counter section despite significant
free space within the store. The pharmacy needs to increase profits, what are two strategies to do
so? correct answers - Over-the-counter products can easily fill in available space and can
increase sales with high margin profits.
- Delivery services for medications may be attractive to certain populations un rural towns.
Patients are expected to pay extra for this service.

What is the Basic Income Statement? correct answers Revenues-Expenses= Net Income

Which are key purposes for the development and use of budgets? correct answers - Planning
- Supporting communicating and coordinating
- Assigning resources
- Assessing performance and benchmarking

Which accounting book is an itemized statement that lists total assets and total liabilities of a
company? correct answers Balance sheet

Which accounting book records the company's revenues and expenses for a specific time period
and is dated for the period ended on a specific date? correct answers Income statement

What is the process of comparing the financial ratios of a single company over several
consecutive years? correct answers Vertical financial analysis

Which accounting book would a manager find the amount the business owed? correct answers
Balance sheet

You work for a large company that runs community pharmacies across the nation. Leadership
wants to compare each pharmacy against NCPA published standards to identify specific areas for
improvement. This type of analysis is called? correct answers Benchmarking

Pharmacies of all types are required to monitor quality performance indicators by which
organizations? correct answers - Third-party payers

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