2014 - Ba - Readiness Quiz 4 - Ga/Df

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  • 1/11 Questions

    What step would you take if a drug is identified as non-covered?

    • Re-verify the drug with the customer
    • Check for the correct spelling of the drug
    • Check drug on Medicare.gov
    • All of the above
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About This Quiz

This 2014 BA Readiness Quiz 4 GA\/DF assesses understanding of pharmacy benefit structures, including drug tier levels, restrictions like step therapy, and handling non-covered drugs. It's designed for professionals managing or learning about prescription drug plans.

Healthcare Quizzes & Trivia

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  • 2. 

    Which of the following would be identified as a deductible for a PDP?

    • A standard amount you pay based on a tier level

    • A fixed amount that must be paid before the plan pays

    • A percentage of the cost that must be paid to the pharmacy

    • Deductibles for PDP are not required

    Correct Answer
    A. A fixed amount that must be paid before the plan pays
    Explanation
    A deductible for a PDP refers to a fixed amount that an individual must pay out of pocket before their insurance plan starts covering the costs. This amount is predetermined and does not change based on the tier level or the cost of the prescription. Once the deductible is met, the insurance plan will then begin to pay for the covered expenses. Therefore, the correct answer is "A fixed amount that must be paid before the plan pays."

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  • 3. 

    Which pharmacy would you expect to get a lower cost for covered drugs? 

    • Network Pharmacy

    • Long Term Care Pharmacy

    • Preferred Network Pharmacy

    • There is no difference in costs on Medicare PDP’s

    Correct Answer
    A. Preferred Network Pharmacy
    Explanation
    A Preferred Network Pharmacy is likely to offer a lower cost for covered drugs compared to other types of pharmacies. This is because Preferred Network Pharmacies have negotiated agreements with Medicare Part D plans to provide discounted prices on prescription medications. These pharmacies are part of a network that has been selected by the plan based on factors such as cost, quality, and convenience. By using a Preferred Network Pharmacy, Medicare beneficiaries can take advantage of the lower cost options available to them.

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  • 4. 

    No special consideration is needed on selecting a plan for someone who is in a nursing home.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Special consideration is needed when selecting a plan for someone who is in a nursing home. Nursing home residents often have unique healthcare needs and require specialized care. Factors such as medication management, assistance with daily activities, and coordination of medical services need to be taken into account when choosing a plan for someone in a nursing home. Therefore, the statement that no special consideration is needed is false.

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  • 5. 

    Which of the following descriptions would best describe a drug restriction?

    • Cost

    • Tier level

    • Non-network Pharmacy

    • Step therapy

    Correct Answer
    A. Step therapy
    Explanation
    Step therapy is a drug restriction that requires patients to first try and fail on a less expensive or preferred medication before they can access a more expensive or non-preferred medication. This approach aims to control costs and promote the use of more cost-effective treatments. It is a common practice used by insurance companies and healthcare providers to ensure appropriate and cost-efficient use of medications.

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  • 6. 

    Prescription drug plans do not require a deductible to be paid for mail orders. 

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Prescription drug plans do require a deductible to be paid for mail orders.

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  • 7. 

    OTC (over the counter) drugs are important to the health of a customer. It is important to collect this information so the customer will have a fair comparison of their total monthly drug cost.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Collecting information about OTC drugs is not important for customers to have a fair comparison of their total monthly drug cost. OTC drugs are typically purchased without a prescription and are not covered by insurance plans. Therefore, their cost is not typically factored into the total monthly drug cost calculation.

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  • 8. 

    A non-preferred generic drug is identified as which tier level in most plans?

    • Tier 1

    • Tier 2

    • Tier 3

    • Tier 4

    Correct Answer
    A. Tier 2
    Explanation
    A non-preferred generic drug is identified as Tier 2 in most plans. This means that it is still a generic drug, but it is not the preferred option and may have a higher cost compared to Tier 1 drugs. Tier 2 drugs generally have a higher copayment or coinsurance amount than Tier 1 drugs, but they are still typically more affordable than brand-name drugs or drugs in higher tiers.

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  • 9. 

    Certain drugs are covered in some plans but not others. A customer demands to know why his drug is not covered. Which of the following would you tell the customer?

    • Some carriers cannot afford to cover the drug

    • Some carriers do not want the risk of providing the drug

    • The drug is not listed in the formulary

    • All of the above

    Correct Answer
    A. The drug is not listed in the formulary
    Explanation
    The customer is informed that the reason his drug is not covered is because it is not listed in the formulary. This means that the specific drug is not included in the list of medications covered by the insurance plan. It could be due to various reasons such as the drug being too expensive for certain carriers to afford or carriers not wanting to take on the risk associated with providing the drug. However, the main reason is that it is simply not included in the formulary.

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  • 10. 

    A non-preferred brand drug is identified as which tier level in most plans?

    • Tier 1

    • Tier 2

    • Tier 3

    • Tier 4

    Correct Answer
    A. Tier 4
    Explanation
    A non-preferred brand drug is identified as Tier 4 in most plans. This tier level indicates that the drug is not preferred by the insurance plan and may have higher out-of-pocket costs for the patient compared to drugs in lower tiers. Tier 4 drugs are typically more expensive or have alternative options available that are preferred by the plan.

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  • 11. 

    When searching for a PCP number for a Humana MAPD, what resources should you use? (Check all that apply)  

    • NPI Registry

    • Humana Physician Finder

    • Call the doctor’s office

    • Type in the doctor’s name and phone number

    Correct Answer
    A. Humana Physician Finder
    Explanation
    The correct answer is Humana Physician Finder. When searching for a PCP number for a Humana MAPD, the recommended resource to use is the Humana Physician Finder. This tool allows you to search for doctors within the Humana network and provides information such as their contact details and PCP number. The NPI Registry can be used to find a doctor's National Provider Identifier, but it may not provide specific information about their affiliation with Humana. Calling the doctor's office or typing in their name and phone number may not necessarily provide the PCP number for a Humana MAPD.

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  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jun 19, 2014
    Quiz Created by
    Bthorup
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