Taiho Oral Oncology Drug Reimbursement Knowledge Review
- 1.Which ONE of the following statements is true?
- A.
Medicare is a single payer with consistent coverage processes for prescription drugs
- B.
Medicare has three benefit programs, two of which cover prescription drugs
- C.
Medicare consists of four benefit programs, two of which cover prescription drugs
- D.
None of the above
- 2.What is the average range of patient coinsurance cost share for oral oncology drugs under MAPD/PDP plans?
- A.
20-25%
- B.
30-35%
- C.
25-33%
- D.
None of the above
- 3.Which of the following statements will likely apply at market launch with commercial payers and MAPD/PDPs for Taiho's new product?
- A.
The drug will likely have a prior authorization requirement
- B.
The drug's coverage will match the FDA approved label
- C.
The drug will likely be positioned on a specialty tier within the payer's formulary
- D.
All of the above
- E.
None of the above
- 4.True or false - a patient that has Medicare Part B benefits automatically has a prescription drug benefit.
- A.
True
- B.
False
- 5.True or false - when a Medicare beneficiary covered under original Medicare (Part A and B) decides to enroll in a stand-alone Part D plan, the premium for the Part D plan is rolled into the Part A/B premium.
- A.
True
- B.
False
- 6.Which of the following statements is true (select one only)?
- A.
Medicare Part D plan premiums, formulary design and patient cost share are all consistent across the US, based on Federal regulations
- B.
Medicare Part D plan premiums are consistent across the US, but each Part D plan can create their own formulary and cost share design
- C.
Medicare Part D formularies are the same across the US, but premiums and cost share may vary by plan
- D.
Medicare Part D premiums, formularies and patient cost share can vary from plan to plan
- 7.Under which of the following Medicare benefits will a cancer patient be able to have coverage for oral oncology drug benefits?
- A.
Medicare Part A
- B.
Medicare Part B
- C.
Medicare Part C
- D.
Medicare Part D
- E.
Medicare Advantage
- F.
MAPD plans
- G.
PDPs
- 8.Which of the following are the most common resources used by payers to support coverage decisions for new FDA approved oral oncology drugs (select all that apply)?
- A.
FDA approval letter
- B.
Most recent ASCO abstracts
- C.
FDA approved product label
- D.
Health technology assessments
- E.
Clinical compendia publications
- F.
All of the above
- G.
None of the above
- 9.True or false - Each state Medicaid fee-for-service agency may differ in how they cover an oral oncology drug.
- A.
True
- B.
False
- 10.In which of the following ways might commercial payers/plans manage the utilization of oral oncology drugs (select all that apply)?
- A.
Comprehensive prior authorizations
- B.
Quantity limits (limiting the number of pills/tablets dispensed per month)
- C.
Formulary tier differentials
- D.
Differing patient copay or coinsurance
- E.
All of the above
- 11.If a Medicare beneficiary is covered by a Medicare Advantage plan, which of the following statements is true?
- A.
The beneficiary will have medical benefits but not pharmacy benefits and will be required to purchase a separate Part D plan
- B.
The beneficiary's current Medicare Part A/B premium level will match the Medicare Advantage plan's premium
- C.
A beneficiary covered under Medicare Advantage cannot purchase a Medicare supplement/Medigap policy to cover the remaining patient cost share responsibility
- D.
All of the above
- 12.True or false - Even if a physician office does not have an onsite pharmacy, that practice is responsible for all work required to process a drug prior authorization to ensure that the utilization of an oral oncology drug is appropriate.
- A.
True
- B.
False
- 13.Which of the following represent the most common access points from which a patient may obtain their oral oncology drug prescription (select all that apply)?
- A.
Community retail pharmacies
- B.
Specialty pharmacies contracted by payers
- C.
Long-term care and home health pharmacies
- D.
Physician offices (through onsite pharmacies or physician dispensing)
- E.
Hospital outpatient pharmacies (whether 340B eligible or not)
- F.
340B contracted pharmacies
- G.
All of the above
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