The Future of Prior Autos

Question 1

Which of the following are characteristics of a Prior Authorization Specialist? Select all that apply
* Ability to answer the request
* Ability to communicate with the necessary parties
* A good understanding of the process
* Ability to identify types of medication

Answer 1

Ability to communicate with the necessary parties, a good understanding of the process, and the ability to answer the request

Question 2

TRUE/FALSE The Centers for Medicare and Medicaid Services announced in their Notice of Benefit and Payment Parameters that insurance plans may use copay accumulator and maximizer programs in 2023.
* TRUE
* FALSE

Answer 2

True

Question 3

What percentage of drug sales is represented by specialty medications?
* 9%-20%
* 69%-80%
* 39%-50%
* 89%-100%

Answer 3

39-50%

Question 4

TRUE/FALSE Copay accumulators and maximizers lead to a loss of mitigation of cost-sharing by the pharmaceutical manufacturers.
* TRUE
* FALSE

Answer 4

True

Question 5

TRUE/FALSE More employment opportunities for prior authorization specialists have become available since the healthcare industry is growing rapidly.
* FALSE
* TRUE

Answer 5

True

Question 6

What is the expected growth of Medicare beneficiaries by the year 2030?
* 10 million
* 1 billion
* 80 million
* 120 million

Answer 6

80 million

Question 7

Jane is a pharmacist and prior authorization specialist. What factors can help Jane process prior authorization requests successfully? Select all that apply
* knowledge of how to find, evaluate, and process the correct information for the patient
* an understanding of how prior authorization works
* a thorough understanding of the “tricks” necessary to get an approval
* an understanding of what role healthcare professionals play in the prior authorization process

Answer 7

all except “a thorough understanding of the “tricks” necessary to get an approval”

Question 8

Choose the reasons why the need for Prior Authorization is rising. Select all that apply
* Medical costs are getting higher and higher
* life expectancy has trended upward in the past decades and is expected to be longer.
* The predicted growth in specialty medications
* Medication costs have decreased

Answer 8

All except “medication costs have decreased”

Question 9

Which of the following organizations recently issued a statement opposing copay accumulator and maximizer programs?
* ASCO
* AMA
* ASHP
* APhA

Answer 9

ASCO

Question 10

Which of the following is the most influential result of copay accumulators?
* Doctors have to file more medical records and requests.
* Patients have to pay higher copays.
* Patients have to be in charge of their own prior authorizations.
* Doctors need to look for cheaper replacements for their prescriptions

Answer 10

Patients have to pay higher copays.