Taiho Oral Oncology Drug Reimbursement Knowledge Review

13 Questions | By Dkpmjt | Updated: Mar 22, 2022 | Attempts: 2747

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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