Chapter 16
What government insurance program is primarily for individuals aged 65 and older or with certain disabilities?
A) Medicaid
B) TRICARE
C) Medicare
D) CHAMPVA
C) Medicare
Which program provides medical care for individuals with income below the national poverty level?
A) Medicare
B) Medicaid
C) Workers’ Compensation
D) PPO
B) Medicaid
What is the brand name for sumatriptan?
A) Zyloprim®
B) Imitrex®
C) Colcrys®
D) Prilosec®
B) Imitrex®
Which of the following foods is known to potentially trigger a migraine headache?
A) Bananas
B) Chocolate
C) Milk
D) Oatmeal
B) Chocolate
All proton pump inhibitors (PPIs) end in which suffix?
A) -prazole
B) -sartan
C) -lol
D) -statin
A) -prazole
Which part of Medicare covers prescription medications?
A) Part A
B) Part B
C) Part C
D) Part D
D) Part D
What does “coordination of benefits” refer to?
A) A pharmacy’s contract with a PBM
B) Submitting a claim to two insurance providers in proper order
C) Determining the patient’s copay
D) Submitting a prior authorization for a brand name drug
B) Submitting a claim to two insurance providers in proper order
What is the brand name for allopurinol?
A) Zantac®
B) Protonix®
C) Zyloprim®
D) Qualaquin®
C) Zyloprim®
Which medication is classified as a triptan and is commonly used to treat migraines?
A) Acetaminophen
B) Sumatriptan
C) Lansoprazole
D) Betamethasone
B) Sumatriptan
Which of the following medications is a histamine H2-receptor antagonist used to treat GERD and ulcers?
A) Esomeprazole (Nexium)
B) Famotidine (Pepcid®)
C) Omeprazole (Prilosec)
D) Aluminum hydroxide
B) Famotidine (Pepcid®)
A prescription claim is denied because it was refilled before 85% of the medication was used. What is the likely rejection reason?
A) Provider not covered
B) Plan limitation exceeded
C) Refill too soon
D) Invalid NDC
C) Refill too soon
Which of the following is a unique identifier often found on an insurance card?
A) BIN number
B) NDC number
C) Lot number
D) DEA number
A) BIN number
What is the generic name for Nexium®?
A) Esomeprazole magnesium
B) Pantoprazole sodium
C) Omeprazole
D) Famotidine
A) Esomeprazole magnesium
What is the primary treatment goal of allopurinol (Zyloprim®) in gout patients?
A) Lower uric acid levels
B) Reduce inflammation
C) Eliminate purines
D) Increase appetite
A) Lower uric acid levels
What is a major counseling point for patients using acetaminophen (Tylenol®)?
A) Avoid dairy
B) Take with high-fat meals
C) May cause ulcers
D) Limit alcohol intake due to liver risk
D) Limit alcohol intake due to liver risk
What does Medicare Part B primarily cover?
A) Hospital inpatient care
B) Prescription medications only
C) Outpatient services, physician visits, and durable medical equipment
D) Hospice care and psychiatric hospitalization
C) Outpatient services, physician visits, and durable medical equipment
A dual eligible patient must have prescription charges billed in which order?
A) Medicaid only
B) Medicare first, Medicaid second
C) Medicaid first, Medicare second
D) Patient pays first, then gets reimbursed
B) Medicare first, Medicaid second
What is the generic name of Medrol®?
A) Prednisone
B) Methylprednisolone
C) Betamethasone
D) Hydrocortisone
B) Methylprednisolone
What bacterial infection is commonly associated with peptic ulcers?
A) E. coli
B) Streptococcus pneumoniae
C) Helicobacter pylori
D) Salmonella typhi
C) Helicobacter pylori
Which corticosteroid is commonly used for psoriasis and comes in topical form?
A) Prednisone
B) Betamethasone (Diprosone®)
C) Methylprednisolone
D) Hydrocortisone
B) Betamethasone (Diprosone®)
What is required for a prescription drug to be covered when prior authorization is needed?
A) The pharmacy must submit a DAW code
B) The technician must approve the override
C) The prescriber must submit documentation to the insurance company
D) The patient must call the pharmacy benefit manager
C) The prescriber must submit documentation to the insurance company
What is the term for comparing submitted claims to benefits and determining if they should be paid?
A) Processing
B) Adjudication
C) Coordination of benefits
D) Claim reversal
B) Adjudication
What is the brand name of acetaminophen?
A) Advil®
B) Motrin®
C) Tylenol®
D) Aleve®
C) Tylenol®
Which medication is used for duodenal ulcers and should be taken on an empty stomach?
A) Esomeprazole
B) Sucralfate (Carafate®)
C) Famotidine
D) Methylprednisolone
B) Sucralfate (Carafate®)
What important patient counseling point is associated with corticosteroids like prednisone and methylprednisolone?
A) Take on an empty stomach
B) Must be tapered when used long-term
C) Best taken at bedtime
D) Avoid dairy products while on therapy
B) Must be tapered when used long-term