PSBP FINAL EXAM WITH ALL CORRECT & 100%
VERIFIED ANSWERS|LATEST UPDATE|ALREADY
GRADED A+
US Healthcare System Structure ✔Correct answer-1. Federal and State Regulating Agencies
2. Insurance Programs
3. Insurance companies, health plans, PBMs ("MCOs")
4. Contracted community providers
5. Program members
Where does pharmacy practice fit into system? ✔Correct answer-through PBMs (Pharmacy
Benefits Manager)
National Health System (NHS) ✔Correct answer-1. corporate collection of healthcare entities and
providers
2. healthcare systems contract with plan sponsors (payers) to provide care to program patients
3. hospital centers, medical groups, pharmacies, and other healthcare providers with a healthcare
system interact with contracted providers and are integrated by contract and electronic health
records in a patient centered medical home
Health Information Exchange ✔Correct answer-1. Medical group
2. Hospital
3. Insurance Company
4. PBM
5. Patients Engagement
6. Pharmacy MUS
Pharmacists and MUS's interact with ✔Correct answer-State regulations
organization policies
wholesaler GPO
pharma companies
quality organizations
insurer, PBM
patient
MDs, HCPs
federal regulations
Board of Pharmacy
Medication Use System (MUS) ✔Correct answer-pharmacists design, implement and manage an
evidence-driven, dynamic MUS to achieve safe and effective patient drug use outcomes
Types of Prescriptions ✔Correct answer-written
faxed
e-scribe
phoned in
transfers
Prescription pathway ✔Correct answer-drop off
, input
input verification
claims adjudication
filling
final verification
bagging
counseling
Claims Adjudication ✔Correct answer-1. process of paying claims submitted or denying them after
comparing claims to the benefits or coverage requirements, sometimes referred to as auto-
adjudication
2. it reviews for errors, eligibility requirements, and deductible payment information
3. if a claim fails the review, it is denied and is returned with a rejection code
National Council for Prescription Drug Programs (NCPDP) ✔Correct answer-created a standardized
list of rejection codes
50: Non-Matched Pharmacy Number ✔Correct answer-1. specialty medication
2. pharmacy is not contracted with the insurance plan
what do you do?
1. contact insurance company to locate nearest acceptable pharmacy
2. alert patient
3. give information to patient
70: Plan Exclusion ✔Correct answer-1. medication is not deemed necessary to maintain life
(obesity treatments, medical foods, fertility treatments)
2. any non-formulary drug
what do you do?
1. alert patient
2. inform patient of cost
3. ask if they want the medication or the prescription back
4. contact physician to switch medication to formulary drug if applicable
75: Prior Authorization ✔Correct answer-1. requires specific clinical criteria to be met before
paying for the medication
2. ensures right patient receives the right medication at the right dose
what do you do?
1. alert patient
2. call insurance company to initiate prior authorization
3. call the provider to give the prior authorization form
4. provider needs to complete the form and follow-up until complete
5. pharmacy should follow-up with provider to verify PA was approved
76: Plan Limitations Exceeded ✔Correct answer-1. step-therapy
2. minimum/maximum age
3. quantity level limit
what do you do?
VERIFIED ANSWERS|LATEST UPDATE|ALREADY
GRADED A+
US Healthcare System Structure ✔Correct answer-1. Federal and State Regulating Agencies
2. Insurance Programs
3. Insurance companies, health plans, PBMs ("MCOs")
4. Contracted community providers
5. Program members
Where does pharmacy practice fit into system? ✔Correct answer-through PBMs (Pharmacy
Benefits Manager)
National Health System (NHS) ✔Correct answer-1. corporate collection of healthcare entities and
providers
2. healthcare systems contract with plan sponsors (payers) to provide care to program patients
3. hospital centers, medical groups, pharmacies, and other healthcare providers with a healthcare
system interact with contracted providers and are integrated by contract and electronic health
records in a patient centered medical home
Health Information Exchange ✔Correct answer-1. Medical group
2. Hospital
3. Insurance Company
4. PBM
5. Patients Engagement
6. Pharmacy MUS
Pharmacists and MUS's interact with ✔Correct answer-State regulations
organization policies
wholesaler GPO
pharma companies
quality organizations
insurer, PBM
patient
MDs, HCPs
federal regulations
Board of Pharmacy
Medication Use System (MUS) ✔Correct answer-pharmacists design, implement and manage an
evidence-driven, dynamic MUS to achieve safe and effective patient drug use outcomes
Types of Prescriptions ✔Correct answer-written
faxed
e-scribe
phoned in
transfers
Prescription pathway ✔Correct answer-drop off
, input
input verification
claims adjudication
filling
final verification
bagging
counseling
Claims Adjudication ✔Correct answer-1. process of paying claims submitted or denying them after
comparing claims to the benefits or coverage requirements, sometimes referred to as auto-
adjudication
2. it reviews for errors, eligibility requirements, and deductible payment information
3. if a claim fails the review, it is denied and is returned with a rejection code
National Council for Prescription Drug Programs (NCPDP) ✔Correct answer-created a standardized
list of rejection codes
50: Non-Matched Pharmacy Number ✔Correct answer-1. specialty medication
2. pharmacy is not contracted with the insurance plan
what do you do?
1. contact insurance company to locate nearest acceptable pharmacy
2. alert patient
3. give information to patient
70: Plan Exclusion ✔Correct answer-1. medication is not deemed necessary to maintain life
(obesity treatments, medical foods, fertility treatments)
2. any non-formulary drug
what do you do?
1. alert patient
2. inform patient of cost
3. ask if they want the medication or the prescription back
4. contact physician to switch medication to formulary drug if applicable
75: Prior Authorization ✔Correct answer-1. requires specific clinical criteria to be met before
paying for the medication
2. ensures right patient receives the right medication at the right dose
what do you do?
1. alert patient
2. call insurance company to initiate prior authorization
3. call the provider to give the prior authorization form
4. provider needs to complete the form and follow-up until complete
5. pharmacy should follow-up with provider to verify PA was approved
76: Plan Limitations Exceeded ✔Correct answer-1. step-therapy
2. minimum/maximum age
3. quantity level limit
what do you do?
