Health Care Economics 2

Question 1

most provines have a public plan for what patient groups?

Answer 1

seniors, low income (family), nursing home, high cost meds (cancer, DM, organ transplant, HIV/aids etc.)

Question 2

what is a premium?

Answer 2

the fee paid at the beginning of joining the program and then annually

Question 3

is the premium for senior pharmacare income-based?

Answer 3

yes

Question 4

what is a copayment?

Answer 4

the portion of the Rx cost that you must pay each time you get an Rx up to a yearly max

Question 5

copayment for family pharmacare is ___%

Answer 5

20

Question 6

in family pharmacare, ____% is paid by the patient until their deductible is reached

Answer 6

80%

Question 7

t/f the deductible in family pharmacare is income-based

Answer 7

t

Question 8

what is MLP?

Answer 8

manufacturer list price

Question 9

what is MRP?

Answer 9

maximum reimbursement price

Question 10

what is PRP?

Answer 10

pharmacare reimbursed price (PRP)

Question 11

what is AAC?

Answer 11

actual acquisition cost (net costs)

Question 12

what are pharmacist prescribed claims?

Answer 12

1. prescribing in an emergency
2. renewals
3. adaptations
4. therapeutic sub
5. schedule 2, 3 and unscheduled prescribing

Question 13

claims for Rx written by PhC that comply with the requirements of the standards are eligible for _____

Answer 13

benefit under the applicable Pharmacare program

Question 14

are “eligible for benefit” under a program the same as “eligible as an insured service”?

Answer 14

NO!

Question 15

who negotiates the price, allowable markups & fees for pharmacy services?

Answer 15

department of health and wellness and PANS

Question 16

price for renewals of 3 or less schedule 1 meds

Answer 16

12$

Question 17

price for 4 or more schedule 1 meds

Answer 17

$20

Question 18

price for adaption, refusal to fill, change in dose/duration etc.

Answer 18

14$

Question 19

price for therapeutic sub for PPIs

Answer 19

26.25$

Question 20

price for UTI, herpes zoster or contraceptive management?

Answer 20

$20

Question 21

if a patient has private & public insurance, who is the payer of last resort?

Answer 21

the public plan (always go through the private plan first)

Question 22

code M means

Answer 22

maximum reimbursement price (MRP)

Question 23

code P means ___

Answer 23

pharmacare reimbursement price (PRP)

Question 24

code L means ____

Answer 24

manufacturer list price

Question 25

the code “C” means

Answer 25

cancer

Question 26

code “D” means

Answer 26

diabetes