Podcast
Questions and Answers
What does the PBM do in terms of pharmacy reimbursement?
What does the PBM do in terms of pharmacy reimbursement?
- Set pharmacy reimbursement rates in individual contracts. (correct)
- Control which drugs eligible members can select.
- Audit pharmacies to prevent fraud.
- Communicate day supply limitations to pharmacies.
How does the PBM use cost sharing and other tools to control drug selection?
How does the PBM use cost sharing and other tools to control drug selection?
- By auditing pharmacies for fraud.
- By recommending cost-effective benefit programs. (correct)
- By checking pharmacy records for duplicate bills.
- By setting day supply limitations.
What is the main purpose of a PBM auditing pharmacies?
What is the main purpose of a PBM auditing pharmacies?
- To offer cost-effective benefit programs.
- To prevent fraud. (correct)
- To communicate formulary to pharmacies.
- To set day supply limitations.
How does the PBM determine the cost of the drug dispensed?
How does the PBM determine the cost of the drug dispensed?
What is one aspect of pharmacy reimbursement mentioned in the text?
What is one aspect of pharmacy reimbursement mentioned in the text?
How do individual pharmacies potentially get a larger discount on drug products?
How do individual pharmacies potentially get a larger discount on drug products?
What is the total reimbursement for 30 tablets of Drug X, given that the AWP for 100 tablets is $650 and the pharmacy purchases it for $533 per 100 tablets?
What is the total reimbursement for 30 tablets of Drug X, given that the AWP for 100 tablets is $650 and the pharmacy purchases it for $533 per 100 tablets?
What is the earned discount (AWP differential) for 100 tablets of Drug X?
What is the earned discount (AWP differential) for 100 tablets of Drug X?
If a pharmacy can buy Drug X for $533 per 100 tablets, what is the dispensing fee for each tablet if the terms of reimbursement are AWP - 15% + $2.25?
If a pharmacy can buy Drug X for $533 per 100 tablets, what is the dispensing fee for each tablet if the terms of reimbursement are AWP - 15% + $2.25?
What would be the total reimbursement for 50 tablets of Drug X if the dispensing fee per tablet is $5.75?
What would be the total reimbursement for 50 tablets of Drug X if the dispensing fee per tablet is $5.75?
If a pharmacy can buy Drug X for $533 per 100 tablets and the AWP for 100 tablets is $650, what percentage discount does the pharmacy get?
If a pharmacy can buy Drug X for $533 per 100 tablets and the AWP for 100 tablets is $650, what percentage discount does the pharmacy get?
What is the purpose of formularies in the context of PBM contracts?
What is the purpose of formularies in the context of PBM contracts?
What does a negative formulary list in a PBM contract indicate?
What does a negative formulary list in a PBM contract indicate?
What is the primary benefit of generic substitution according to the text?
What is the primary benefit of generic substitution according to the text?
Why do PBMs negotiate drug manufacturer rebates for preferred status on formularies?
Why do PBMs negotiate drug manufacturer rebates for preferred status on formularies?
What is a 'therapeutic switch' as mentioned in the text?
What is a 'therapeutic switch' as mentioned in the text?
Why is therapeutic interchange sometimes difficult in community practice according to the text?
Why is therapeutic interchange sometimes difficult in community practice according to the text?
Why might maintaining participation in unprofitable 3rd party plans sometimes lead to more profit dollars at the end of the year?
Why might maintaining participation in unprofitable 3rd party plans sometimes lead to more profit dollars at the end of the year?
Why might patients prefer personalized service in community pharmacies over mail-order services?
Why might patients prefer personalized service in community pharmacies over mail-order services?
What impact can providing good service to patients have on their likelihood to use mail order pharmacies?
What impact can providing good service to patients have on their likelihood to use mail order pharmacies?
What is a common trend regarding PBMs' reimbursement terms in recent years?
What is a common trend regarding PBMs' reimbursement terms in recent years?
What incentive do PBMs offer pharmacies to accept lower reimbursement rates and dispensing fees?
What incentive do PBMs offer pharmacies to accept lower reimbursement rates and dispensing fees?
How often do PBMs typically pay pharmacies based on the text?
How often do PBMs typically pay pharmacies based on the text?
What is the main difference between retrospective DUR and prospective DUR?
What is the main difference between retrospective DUR and prospective DUR?
How have pharmacists adapted to survive PBM cost cutting?
How have pharmacists adapted to survive PBM cost cutting?
What steps are mentioned towards payment for advanced patient care services?
What steps are mentioned towards payment for advanced patient care services?
When does Prospective DUR occur?
When does Prospective DUR occur?
What is another name for Prospective DUR?
What is another name for Prospective DUR?
What have P&T committee members shown interest in regarding drug use?
What have P&T committee members shown interest in regarding drug use?
