Chapter 2 & 3

What type of health insurance plan increases patient awareness of health care costs?

Which of these formularies features can employers choose to customize the health plan option they offer their employees

The amount of time that must pass before a newly hired employee or a dependent is eligible to enroll in a health plan is

Beneficiaries must fill prescriptions at member pharmacies for the best price, except in certain cases involving:

Which of these health plans has a high deductible in a low premium?

Which of these tasks is not a common function of pharmacy benefit managers?

Dispensing drugs by mail order pharmacies is discouraged by employers

Many pharmacy benefit managers provide disease management programs for common & potentially high cost conditions such as

What is the substitution of one drug for another in the same therapeutic class called?

What percent of people with purchasers of private insurance are likely to include all of the following except:

Non-covered expenses are defined as those the policy does not cover that must be paid by the insured

What type of health insurance plan only covers network providers visits?

What type of review may be required to be conducted by a plan before medications or dispensed or even prescribed?

A third-party administrator of prescription drug programs that process and pays prescription drug claims is called a(n):

Good passwords are those that are easy to remember and have words and names in them?

A PCP is also known as a:

Specialty drugs may include biotech and other drugs that are designed to treat serious diseases.

PBM’s are hired by employers to operate their prescription drug benefits more inexpensively?

Many employees have medical insurance coverage under GPH that their employers buy from:

Which of the following methods do employees in PBM‘s not used to control health plan costs?

Employees can customize their policies by choosing to except various levels of:

The amounts that a health plan pays are referred to out-of-pocket expenses

How much money would it patient out on a $300 prescription if their coinsurance was 25%?

Which of these health plans allows beneficiaries to see provider is in network only?

Payers do not require patients to pay for noncovered (excluded) services

What type of formulary limits the drug listed to only generics, or limited medications within a drug class?

HMO or the most popular type of MCO?

Formularies are managed by the pharmacy benefit manager into:

Therapeutic interchange encourages formulary compliance

Open enrollment periods are usually offered:

Which of these techniques is used by employers-primarily through their PBM’s to control costs?

What information would probably not be found on a patient’s medical insurance ID card?

And open formulary will sometimes cover medications that are not listed on the formulary

A PPO is a managed care organization that creates a network of all but which of the following?

The HIPAA privacy rule has requirements that cover patients’ health information

In some health maintenance organization plans, a PCP, also known as a gatekeeper, is assigned to each patient

Pharmacy benefits do not include:

Many employees have medical insurance coverage under GHP that their employers buy from insurance companies.

Which of these health plans generally has the largest membership?

The most restrictive type of formulary is known as restricted formulary?

The highest-cost option type would likely feature:

Each tier within a formulary represents a different cost to the beneficiary

What type of health insurance plan features higher costs for out-of-pocket providers?

The HIPAA of 1996 was not designed to uncover fraud and abuse

The minimum necessary standard means taking reasonable safeguards to protect PHI from incidental disclosure

Copayments are always due and collected at the same time of service

What name is given to medication required “Caution: federal law prohibits dispensing without a prescription”?

Which tool is used to control costs by ensuring safety, improving care quality, & promoting compliance with a formulary