PSBP Final Exam questions with
verified answers rated 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
verified answers rated 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
