7
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| Define generic name for a drug. | A term referring to the chemical makeup of a drug rather than to the advertised brand name under which the drug is sold.
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| What is the main difference between an HMO and a PPO? | The difference between HMO's and PPo's is that the patient usually pays more out-of-pocket expenses for PPO's.
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| Identify which government agency runs Medicaid and which one runs Medicare. | Medicare is run by the federal government and medicaid is run by each state.
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| Do all pharmacies have to accept all insurances? | No.
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| What does the term rotating stock mean? | When you put the medications that are about to expire in the front and put the newer medications in the back.
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| Are reconstituted cytotoxic agents returnable to the manufacturer? | No.
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| Define formulary. | The formulary is a list that describes all the medications covered under the insurance plans.
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| Why is it that most insurance companies will only cover generic name drugs? | Because they are cheaper.
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| Who is responsible for contacting the patient who may have received a recalled drug from the pharmacy? | The pharmacist.
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| Which type of drugs comes with paper work that must be completed and returned to the manufacturer each time that a medication is given? | Controlled substances, investigational drugs, and cytotoxic drugs.
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| Which party does third-party billing refer to? | The insurace company.
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| Identify the various types of HMO's discussed in this module. | Blue cross, united health care, pacific care, campus tricare program & kiaser.
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| Identify the features of HMO's. | They have a primary care physician, independent physician association, and copay.
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| Identify the insurance program that covers low-income residents. | Medicaid.
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| What is the process by which all claims are processed over a computer system called? | Adjudication.
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| Identify the common reasons that a prescription may not be covered. | Coverage has expired, coverage limits have been exceeded, NDC is not covered, patient is trying to refill a prescription to early, the card holder's information does not match the processors information, or the doctor is not the primary care physician.
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| What is the minimum amount of medication that should be maintained in the pharmacy? | The periodic automatic replenishment level.
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| Identify the possible reason for reterning drugs to the manufacturer. | Drug recalls, damaged stock, or expired stock.
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| Who is responsible for maintaining the inventory in the pharmacy? | Every one working in the pharmacy.
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| What is it called if the provider requires a predetermined amount to be paid for office visits? | Copay.
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| Identify the information that an insurance company needs when processing a prescription. | Patients name, date medication is filled, pharmacy name and address, medication prescribed, dosage, DOB, and ID number.
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| Which book should be used to determine the price of a medication based on the manufacturers price. | The red book.
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| Identify where the pharmacy technician would normally order medications? | Centralized warehouce that the pharmacy knows from a whole seller or directly from the manufacturer.
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| What is it called if the provider allows the patient to choose a main physician rather than having to be seen by the physician on duty? | PPO.
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