Drug
Who pays for workers compensation? pg 296
The employer
What is IPA? pg 290
Independent Physicians Association
In what year did Medicare and Medicaid become active? pg 291
1965
What is the copayment? pg 287
This refers to the portion of the prescription bill that the patient is responsible for paying
Who is eligible for Medicare coverage? pg 291
Elderly - over 65 years of age
Persons younger than 65 with long term disabilities
Patients with End Stage Renal Disease (ESRD) that are on dialysis
What is a back-ordered item? pg 304
The ordered item is not currently in stock but will be sent as soon as it is available
Name the Government managed programs. pg 291 & 295
Medicare, Medicaid, TRICARE, and CHAMPVA
Which system automatically monitors and tracks inventory? pg 305
Automated Dispensing Systems
What methods will the pharmacy tell a patient to dispose of a medication? pg 308
Mix them in coffee grounds or kitty litter, but never flush them down the toilet
What is PAR? pg 287
Periodic Automatic Replenishment
It covers physician and other outpatient services, including diabetes testing, physical therapy, and other preventative costs
What is PPO? pg 291
Preferred Provider Organization
What are the reasons an insurance company would reject a claim? pg 300
Refill is requested too early
Patient’s identification does not match the processor’s information
Policy has expired
What is 3rd party billing? pg 297
This refers to the portion of the payment reimbursed by the insurance company
What does POS billing allow the insurance company to do? pg 297
The insurance company can verify eligibility, identify covered drugs, price a claim, and respond to pharmacies within seconds
In what situations would an insurance company allow the patient to refill their medications early? pg 302
An extended vacation, or a disaster situation
For what reasons can a medication be returned to the manufacturer or warehouse for credit? pg 307
Drug was recalled
Drug is damaged
Drug is expired or about to expire
Which Insurance plan requires a patient to have a PCP? pg 290
HMO
What type of drugs are normally included on a Formulary and why? pg 289
generic drugs - they are just as effective as brand name drugs but are less expensive
What is AWP? pg 287
Average Wholesale Price
What is a DAW 1? pg 289
When a physician insists that the Trade or Brand name medication is medically necessary for the patient.
Make sure you know DAW 0, 1 and 2
Who issues prescription coupon cards? pg 303
Drug manufacturers
What information can be found in the barcode? pg 305
Drug, strength, form, quantity, cost, and package size
What does stock rotation mean? pg 304
Bringing the items with the earliest expiration dates to the front so they are used first
What are the types of plan limitations? pg 303
Step therapy
Day supply
Refill Limits
Prior Authorization
Maximum amount that can be dispensed at one time