PTCB Exam Study Guide:
GRADED A+. Practice
Questions and Verified
Answers. Latest 2026 Update
Health Care system - Ans✔✔-According to the World Health Organization
(WHO), a health care system is defined as a system that consists of
organizations, institutions, and resources of people whose primary purpose is
to improve public health
Medicare - Ans✔✔-Provides service for the elderly and disabled individuals
(must meet a certain criteria)
Medicaid - Ans✔✔-Provides service for lower income individuals. Federally and
state funded
Tricare - Ans✔✔-AKA military insurance; provides service to veterans and
soldiers
NIH - Ans✔✔-National Institute of Health
,Employer Insurance - Ans✔✔-Most employers provide health insurance to full
time employees
Private Insurance - Ans✔✔-Individuals can apply and pay for health insurance.
Smaller businesses offer group rates to their employees.
Copay - Ans✔✔-The remaining amount an individual must pay for their
medication after insurance. This form of payment is collected at the point of
sale (ie the pharmacy)
Medicare A - Ans✔✔-Covers inpatient hospital stays
Medicare B - Ans✔✔-Covers outpatient hospital stays and diabetic supplies,
DME (durable medical equipment), patients on long term disabilities, X-rays,
dialysis, vaccines, and respiratory nebulizers
Medicare C - Ans✔✔-Additional coverage not covered under A or B. Often
called the advantage plan or choice plan.
Medicare Part D - Ans✔✔-Covers prescription medications; usually processed
by private insurance but funding is provided by CMS (government)
Medicare Part E - Ans✔✔-Supplemental coverage; covers A, B, and D (Different
than just Medicare C)
Medicare C only covers A and B
,HMO - Ans✔✔-Health Maintenance organization
Health Maintenance Organization (HMO) - Ans✔✔-With an HMO plan, you
must select a primary care physician (PCP) from .a network of local healthcare
providers who will refer you to in-network specialists or hospitals when
necessary.
All of your care is coordinated through your PCP
Lost cost to the insurance and the patient
PPO - Ans✔✔-preferred provider organization
Perferred Provider Organization (PPO) - Ans✔✔-Recommended list of in-
network providers and hospitals
-If you choose a provider outside of your network, your copay may be higher
-More flexibility= pay more money per month
EPO - Ans✔✔-Exclusive Provider Organization
Exclusive Provider Organization (EPO) - Ans✔✔-Sort of like a combination
between HMO's and PPO's
-There is a recommended list of providers and specialists but cannot pick a
provider outside of network
-You can pick any primary care physician but they must be in-network
, Workers Compensation - Ans✔✔-When a patient has been hurt at work and
his/her company has agreed to pay for the cost of his/her medication
out of pocket - Ans✔✔-Individuals without health care coverage and have to
pay out of pocket expenses
Pharmacy Benefit Managers - Ans✔✔-PBM
-Primarily responsible for developing and maintaining the formulary,
contracting with pharmacies, negotiating discounts and rebates with drug
manufacturers, and processing and paying prescription drug claims.
-Working with self-insured companies and government programs; trying to
reduce pharmacy expenditures of the plan and trying to improve health
outcomes
Drug Development - Ans✔✔-Complex and time consuming; on average it takes
8-15 years for a drug to be developed and approved by the Food and Drug
Administration
3 Basic Steps of Drug Development - Ans✔✔-1. Research
2. Testing
3. Approval
Research - Ans✔✔-Can be done be pharmacologists, toxicologists, clinical
pharmacologists, pharmacists, and physicians
-The objective of research is to find a new active ingredient or to modify the
structure of existing drugs
GRADED A+. Practice
Questions and Verified
Answers. Latest 2026 Update
Health Care system - Ans✔✔-According to the World Health Organization
(WHO), a health care system is defined as a system that consists of
organizations, institutions, and resources of people whose primary purpose is
to improve public health
Medicare - Ans✔✔-Provides service for the elderly and disabled individuals
(must meet a certain criteria)
Medicaid - Ans✔✔-Provides service for lower income individuals. Federally and
state funded
Tricare - Ans✔✔-AKA military insurance; provides service to veterans and
soldiers
NIH - Ans✔✔-National Institute of Health
,Employer Insurance - Ans✔✔-Most employers provide health insurance to full
time employees
Private Insurance - Ans✔✔-Individuals can apply and pay for health insurance.
Smaller businesses offer group rates to their employees.
Copay - Ans✔✔-The remaining amount an individual must pay for their
medication after insurance. This form of payment is collected at the point of
sale (ie the pharmacy)
Medicare A - Ans✔✔-Covers inpatient hospital stays
Medicare B - Ans✔✔-Covers outpatient hospital stays and diabetic supplies,
DME (durable medical equipment), patients on long term disabilities, X-rays,
dialysis, vaccines, and respiratory nebulizers
Medicare C - Ans✔✔-Additional coverage not covered under A or B. Often
called the advantage plan or choice plan.
Medicare Part D - Ans✔✔-Covers prescription medications; usually processed
by private insurance but funding is provided by CMS (government)
Medicare Part E - Ans✔✔-Supplemental coverage; covers A, B, and D (Different
than just Medicare C)
Medicare C only covers A and B
,HMO - Ans✔✔-Health Maintenance organization
Health Maintenance Organization (HMO) - Ans✔✔-With an HMO plan, you
must select a primary care physician (PCP) from .a network of local healthcare
providers who will refer you to in-network specialists or hospitals when
necessary.
All of your care is coordinated through your PCP
Lost cost to the insurance and the patient
PPO - Ans✔✔-preferred provider organization
Perferred Provider Organization (PPO) - Ans✔✔-Recommended list of in-
network providers and hospitals
-If you choose a provider outside of your network, your copay may be higher
-More flexibility= pay more money per month
EPO - Ans✔✔-Exclusive Provider Organization
Exclusive Provider Organization (EPO) - Ans✔✔-Sort of like a combination
between HMO's and PPO's
-There is a recommended list of providers and specialists but cannot pick a
provider outside of network
-You can pick any primary care physician but they must be in-network
, Workers Compensation - Ans✔✔-When a patient has been hurt at work and
his/her company has agreed to pay for the cost of his/her medication
out of pocket - Ans✔✔-Individuals without health care coverage and have to
pay out of pocket expenses
Pharmacy Benefit Managers - Ans✔✔-PBM
-Primarily responsible for developing and maintaining the formulary,
contracting with pharmacies, negotiating discounts and rebates with drug
manufacturers, and processing and paying prescription drug claims.
-Working with self-insured companies and government programs; trying to
reduce pharmacy expenditures of the plan and trying to improve health
outcomes
Drug Development - Ans✔✔-Complex and time consuming; on average it takes
8-15 years for a drug to be developed and approved by the Food and Drug
Administration
3 Basic Steps of Drug Development - Ans✔✔-1. Research
2. Testing
3. Approval
Research - Ans✔✔-Can be done be pharmacologists, toxicologists, clinical
pharmacologists, pharmacists, and physicians
-The objective of research is to find a new active ingredient or to modify the
structure of existing drugs
