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25 Cards in this Set
- Front
- Back
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Define generic name for a drug
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name assigned to a medication by the FDA
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What is the main difference between an HMO and PPO?
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the patient pays more out of pocket expenses for PPO
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Identify which government agency runs Medicaid and which runs Medicare
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Medicaid-state
Medicare-federal |
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Do all pharmacies have to accept all insurances?
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No
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What does the term rotating stock mean?
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new stock has later expiration dates so they should be placed behind the existing stock that expires sooner
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Are reconstituted cytotoxic agents returnable to the manufacturer?
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No
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Define formulary
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A list that describes all the medications covered under insurance plans
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Why is it that most insurance companies will only cover generic name drugs?
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The cost of the generic drug
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Who is responsible for contacting the patient who may have recieved a recalled drug from the pharmacy?
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Pharmacists
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Which type of drugs come with paperwork that must be completed and returned to the manufacturers each time that a medication is given?
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investigational drugs
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What is a list of medications covered under insurance plans called?
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Formularies
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Which party does third-party billing refer to?
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The third part of the three parties
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Identify the various types of HMOs discussed in this module.
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Blue Cross, United Healthcare, Pacificare, Champus Tricare Program and Kaiser
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Identify the features of HMOs
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1. Primary care physician
2. Independent physician association 3. Copay |
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Identify the insurance program that covers low-income residents.
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Medicare
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What is the process by which all claims are processed over a computer system called?
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Ajudication
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Identify the common reasons that a prescription may not be covered.
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-Coverage has expired
-Coverage limits have been exceeded -National Drug Code(NDC) is not covered -Patient is trying to refill a prescription too soon -The cardholders information does not match the processors information -Doctors is not the primary care physician |
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What is the minimum amount of medication that should be maintained in the pharmacy?
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Periodic Automatic Replenishment level (PAR)
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Identify the possible reason for returnng drugs to the manufacturers
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drug recalls, damaged stock, expired stock
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Who is responsible for maintaining the inventory in the pharmacy?
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everyone in the pharmacy
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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?
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Primary care physician
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What is it if the provider requires a predetermined amount to be paid for office visits?
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Copay
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Identify the information that an insurance company needs when processing a prescription
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-Patient name
-Date medication filled -Pharmacy name and address -Medication prescribed -Dosage -DOB -Identification # |
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Which book should be used to determine the price of a medication based on the manufacturers price?
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Red book or Blue book
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Identify where the pharmacy technician would normally order medications
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Warehouse from wholesalers or directly from manufacturers
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