Exam 2 Practice Questions

Question 1

Which of the following drug prices is used predominantly by Medicare and Medicaid as the maximum cost for drugs
billed to these programs?
A. Average Wholesale Price (AWP)
B. Wholesale Acquisition Cost (WAC)
C. Estimated Acquisition Cost (EAC)
D. Federal Upper Limit (FUL)

Answer 1

D. Federal Upper Limit (FUL)

Question 2

The difference between the amount a PBM charges a patient’s insurance and what the PBM pays the pharmacy is referred to as:
A. Gross Margin
B. Spread Pricing
C. Rebates
D. Dispensing Fee

Answer 2

B. Spread Pricing

Question 3

Your pharmacy has a contract with Bearcat PBM. Your contract specifies you can bill the lowest of:
1. AWP - 18% plus a dispensing fee of $6.00
-or2. Usual and Customary cash price
6. Patient pays the co-pay: $210.00 - $40.00 = $170.00 (this is the MAX you can bill to the PBM)
A. < $150.00
B. Between $165.00 and $175.00
C. Between $200.00 and $220.00
D. Between $225.00 and $235.00
E. > $250.00

Answer 3

B. Between $165.00 and $175.00

Question 4

Refer to the question above. Your pharmacy can purchase Crestor for WAC cost. What was the Gross Margin for this
prescription? (Remember the gross margin is the total revenue minus the cost of the drug. It’s the amount leftover to
cover your business expenses and profits)
Solution:
1. Total revenue into the store: $210.00
2. Cost for 30 Crestor (WAC) = $217.67
3. You LOST $7.67 on this Rx (this is NOT an unusual situation!)
A. < $0.00
B. Between $5.00 and $20.00
C. Between $25.00 and $50.00
D. > $50.00

Answer 4

A. < $0.00

Question 5

Medicare Part B primarily reimburses for what type of health care services?
A. inpatient hospital
B. physician
C. community pharmacy prescriptions
D. skilled nursing (nursing home)

Answer 5

B. physician

Question 6

Refer to the Medicare Part D Benefit Plan for 2021 shown below. Grandma Govel receives 1 prescription each month.
Her prescription is an expensive Tier 4 drug with a co-payment of $105 dollars. Before her Part D coverage kicks in, the
prescription cash price is $220.43.
What is the FIRST month she will receive any Part D coverage assistance?
A. January
B. February
C. March
D. December
E. She will not get any help during the year

Answer 6

C. March

Question 7

Refer to the question above. In what month will Grandma Govel hit her Catastrophic Coverage limit?
A. January
B. February
C. March
D. December
E. She will not hit this threshold in the year

Answer 7

E. She will not hit this threshold in the year

Question 8

The most expensive category of Medicaid beneficiaries is:
A. elderly beneficiaries in nursing homes
B. children
C. working age adults
D. disabled adults (ex. Pts with End-Stage Renal Disease)

Answer 8

A. elderly beneficiaries in nursing homes

Question 9

Citizens can become eligible for Medicaid through which of the following categories?
[Select all that apply]
A. meeting the criteria for mandated categorically needy
B. meeting the criteria for state specific optional criteria
C. meeting the criteria for medically needy which results from devastating medical expenses
D. meeting the criteria for being disabled with End Stage renal Disease

Answer 9

A. meeting the criteria for mandated categorically needy
B. meeting the criteria for state specific optional criteria
C. meeting the criteria for medically needy which results from devastating medical expenses

Question 10

The Patient Protection & Affordability Care Act (PPACA) included the individual mandate for health insurance.
This term is best defined as:
A. individuals are responsible for getting health insurance similar to getting a driver’s license
B. individuals can use health savings accounts if they have a high-deductible health plan
C. all individuals can qualify for Medicaid if their state expanded their coverage
D. young adults staying on their parents insurance until age 26
E. protecting individual health data from being disclosed to non-authorized persons

Answer 10

D. young adults staying on their parents insurance until age 26

Question 11

The approval of biosimilars is different from the approval of traditional small molecule drugs in which way(s):
[select all that apply].
A. biosimilars are tested against a placebo rather than testing against a reference product
B. biosimilars must prove they are structurally identical to the reference product
C. biosimilars are strongly scrutinized for any potential immunogenicity compared to the reference product
D. biosimilars must demonstrate “highly similar” activity not identical kinetics and metabolism

Answer 11

C. biosimilars are strongly scrutinized for any potential immunogenicity compared to the reference product
D. biosimilars must demonstrate “highly similar” activity not identical kinetics and metabolism

Question 12

When hospitals acquire other businesses like physician office practices, laboratories, or community pharmacies in order to maintain or increase their revenues, this is an example of
A. vertical integration
B. horizontal integration
C. mergers
D. Accountable Care Organizations
E. capitation arrangements

Answer 12

A. vertical integration