Managed Care Quiz

15 Questions

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Care Quizzes & Trivia

Questions and Answers
  • 1. 
    In a three-tier formulary, which is the most likely formulary tier position for an “advantaged” branded product?
    • A. 

      Tier 1

    • B. 

      Tier 2

    • C. 

      Tier 3

    • D. 

      Tier 4

  • 2. 
    • A. 

      Tier 1, Generic

    • B. 

      Tier 2, Preferred Brand (at par)

    • C. 

      Tier 2, Preferred Brand (exclusive)

    • D. 

      Tier 3, Brand

  • 3. 
    In a 4-tier formulary, which types of products are typically listed on Tier 4?
    • A. 

      Specialty pharmaceuticals / injectables

    • B. 

      Over-the-counter (OTC) brands

    • C. 

      Non-preferred oral medications

    • D. 

      Preferred oral medications

  • 4. 
    • A. 

      Preferred generic on Tier 1

    • B. 

      Preferred brand, exclusive listing on Tier 2

    • C. 

      Preferred brand, at-parity listing on Tier 2

    • D. 

      Non-preferred brand on Tier 3

  • 5. 
    Among managed care step-therapy protocols, at which step is the utilization of a preferred brand usually implemented?
    • A. 

      Step 1

    • B. 

      Step 2

    • C. 

      Step 3

    • D. 

      Step 4 or higher

  • 6. 
    Among the following choices, which is the most effective strategy when your branded product is subject to a step edit?
    • A. 

      Promote another product in your company’s portfolio.

    • B. 

      Differentiate the product clinically whenever you can do so.

    • C. 

      Present the product as “best in class” regardless of restrictions.

    • D. 

      Leave samples, as this helps physicians avoid prescribing restrictions.

  • 7. 
    • A. 

      Low

    • B. 

      Moderate

    • C. 

      High

    • D. 

      Equivalent to a Step 2 agent

  • 8. 
    The most common benefit design used by health plans is:
    • A. 

      2 tier closed

    • B. 

      3 tier open

    • C. 

      5 tier specialty

    • D. 

      2 tier open

  • 9. 
    When a health plan reviews past drug usage patterns and informs physicians of areas where prescribing patterns may be changed is called:
    • A. 

      Concurrent DUR

    • B. 

      Therapeutic Substitution

    • C. 

      Retrospective DUR

    • D. 

      Therapeutic Interchange

  • 10. 
    • A. 

      Prior Authorization

    • B. 

      Therapeutic Interchange

    • C. 

      Step Edit

    • D. 

      Generic Substitution

  • 11. 
    In a step edit protocol, which product is likely to be recommended as first-line treatment?
    • A. 

      A less expensive Tier 1 generic

    • B. 

      A Tier 3 branded product

    • C. 

      A Tier 4 or 5 medication

    • D. 

      A nonformulary agent

  • 12. 
    Prior Authorizations steer physicians to:
    • A. 

      Inferior therapeutic decisions

    • B. 

      Cost effective alternative agents

    • C. 

      Withhold required therapy

    • D. 

      The most costly therapeutic alternative

  • 13. 
    Medicare Part D refers to:
    • A. 

      Hospital insurance; an entitlement given to everyone who qualifies for Medicare

    • B. 

      Medical insurance that covers physician services for Medicare beneficiaries

    • C. 

      Optional outpatient prescription-drug benefit for Medicare beneficiaries created by the Medicare Modernization Act

    • D. 

      Prescription drug plan that federally subsidizes a patient’s co-pay

  • 14. 
    The federal agency within the Department of Health and Human Services that manages two national health care programs covering 100 million lives is called:
    • A. 

      National Institutes of Health (NIH)

    • B. 

      Centers for Disease Control (CDC)

    • C. 

      Agency for Healthcare Research (AHR)

    • D. 

      Centers for Medicare and Medicaid Services (CMS)

  • 15. 
    • A. 

      Health Care and Education Reconciliation Act

    • B. 

      Patient Protection and Affordable Care Act

    • C. 

      The Sunshine Act

    • D. 

      Health Insurance Portability and Accountability Act