Quiz questions second half Flashcards
(32 cards)
There is a 17-year difference in life expectancy between certain zip codes in the Indy area (T/F)
True
What is the impact of enhancing clinical care on overall health for most populations?
20%?
There is no difference in overall health status between high and low income populations (TF)
False
Which of the following types of insurance plans is usually associated with the highest costs?
A. PPO plan
B. HMO plan
C. POS plan
D. HDHP plan
E. Conventional plan
Conventional Plan
The major shift to managed care plans has been driven by which of the following?
A. Improve efficiency
B. Control costs
C. Prevent disease
D. Improve outcomes
E. Improve accessibility
Control costs
Healthcare expenditures in US have inc dramatically since 1960 but have leveled off during past 5 years (T/F)
false ??
Drugs supplied via specialty pharmacies are most likely to be place on which tier of managed drug plan
Tier 4
In which of the following managed care plans do PROVIDERS assume some risk
ACO
If i have health insurance, all my expenses will be covered (t/f)
false
Employers pay 25-30% of total annual salary for benefits (t/f)
True
-may have to reduce salary tho
People need health insurance bc health care is expensive (t/f)
true, but main reason is because health is unpredictable
Current industry standard for sharing healthcare costs between employers and emlpoyees is now what
75/25
Purdue employees have to meet deductible each year before ANY preventative med service or rx are covered (t/f)
false
Which of the following is true about self-insured health plans?
A. Usually offered by smaller employers
B. The insurance company assumes the risk for health coverage
C. Must comply with all state-mandated benefits
D. Allows for more customization of plans
Allows for more customization of plans
The facility or loaction when procedures are done have minimal impact on costs for purdue employees and university
False
If employee wants consumer driven health insurance plan w lowest possible premium, plan will likely feature:
A. Higher deductible
B. Higher maximum out of pocket expenses
C. Less choice of providers
D. A and B
E. B and C
-Higher deductible and higher max out-of-pocket expenses
Mr. Musial began his pharmacy career at which of the following?
A. CVS Pharmacy
B. Osco Pharmacy
C. Albertson’s
D. MD Wise
E. Indiana Medicaid
Osco Pharmacy
A large percentage of the pharmacists’ time on Mr. Musial’s team is spent doing which of the following?
A. Generating analytic reports
B. Processing PAs
C. Formulary issues
D. Providing clinical consults
Processing PAs
IN Medicaid will cover semaglutide for a patient with sleep apnea but not for weight loss. T/F
True
In Indiana, the Preferred Drug List dictates which drugs are covered on the Medicaid formulary. T/F
True
The goal of the vast majority of PBMs is to make a profit for their shareholders. T/F
True
In 2023, the majority of PBM profits are associated with which
of the following?
A. Rebates from manufacturers
B. Administrative fees
C. Specialty pharmacies they own
D. Mail order pharmacies they own
Specialty pharmacies they own
Most formulary decisions are driven by clinical ramifications rather than the PBM’s financial interest. T/F
False
The VA health care system is the largest managed care organization in the US. T/F
True
