This regimen utilizes alternative and less costly medication to be tried first and only in the case of failure will a more expensive one be covered.
What is step therapy.
100
A continued updated list of medications whose purpose it to encourage the use of safe, effective, and most affordable medications
What is a formulary
100
MediCal's prior authorization process cannot exceed this number of PAs for prescriptions a month?
What is 6 TAR (Treatment authorization requests) a month.
100
This medical plan choice allows patients to gain more flexibility in doctor specialist selection.
What is PPO (Preferred Provider Organization).
100
This federal statute, passed in March 2010, implemented significant regulatory reform to health care and health insurance.
What is The Affordable Care Act.
200
This message will show when a patient tries to refill a 30-day medication 15 days after the most recent fill?
What is Refill Too Soon.
200
This plan design involves the member paying the same copay for all drugs.
What is a single copay prescription drug benefit.
200
These dates are the open enrollment periods for MediCare Part D.
What is What is Oct 15th – December 7th
200
This practice or arrangement guarantees compensation of loss by sharing risk among different individuals.
What is insurance.
200
The new law forbids insurance companies from doing these three previous actions.
What is dropping coverage due to illness, pre-existing condition clauses, and consideration of current health status
300
Coordination of benefits describes the process when two insurance companies do what task?
What is coordinate payment so that there is no co-pay (zero balance).
300
This insurance processing ensures appropriate cost-effective use of medications and provide coverage determinations and often involves step therapy in order to achieve an approval.
What is a Prior Authorization.
300
Lab tests and vaccinations are generally covered under this Medicare component.
What is Medicare Part B.
300
Individuals spend the most money on this health care service.
What is hospital care.
300
This component of the law requires all individuals to purchase health insurance should their employer not offer it.
What is the individual mandate
400
This level of government is always billed first for patients with dual coverage?
What is Federal.
400
Pharmacoeconomics involves the balance of these two drug properties in order to determine whether or not a drug should be added to a formulary.
What are clinical advantages and costs.
400
A gap in Medicare Part D coverage that results in complete out of pocket expenses between $2,700–$6,154 of total drug spent is often referred to as this.
What is the donut hole.
400
This is the amount a patient must pay 100% of their cost before an insurance plan can begin to cover medication.
What is a deductible.
400
These two groups of people are exempt from penalties outlined in the Obamacare legislation?
What are undocumented immigrants and incarcerated individuals.
500
A statement written by the doctor on a medication prescription that does not allow generic substitution.
What is Dispense as Written
500
These professionals are responsible for drug benefit design and cost management of drug distribution and dispensing.
What are managed care pharmacists.
500
A patient who has both MediCal and MediCare is often referred to as this.
What is Medi-Medi patient.
500
These participants of health insurance make up the critical component of the American Health Insurance system. (HINT: 4 P's
What are providers, payors, plans, and patients.
500
This website is used to enroll individuals into the health benefits exchange markets.