Q: Which equation best represents the pricing model for Mark Cuban CostPlus Drugs?

$$\text{Total Price} = (\text{Manufacturing Cost}) + 0.15 \times (\text{Manufacturing Cost}) + \text{Pharmacy Labor} + \text{Shipping} + \text{Credit Card Processing Fee}$$

Question 1

Which of the following is a key difference between private and public payers of healthcare in the United States?

Accepted Answer

Private payers contract independently with employers or individuals, while public payers are funded and administered by the government.

Question 2

A patient loses their job in November and is considering COBRA and ACA Marketplace coverage. Which statement is most accurate regarding their options?

Accepted Answer

COBRA allows immediate continuation of coverage, but the patient is responsible for the full premium cost.

Question 3

Which of the following is NOT a required essential health benefit under the Affordable Care Act (ACA) Marketplace plans?

Accepted Answer

Cosmetic surgery

Question 4

A pharmacist wants to bill Medicare for durable medical equipment (DME). Which of the following is required for the claim to be paid?

Accepted Answer

A diagnosis code, prescriber’s NPI, and specific frequency of use must be included.

Question 5

Which equation best represents the pricing model for Mark Cuban CostPlus Drugs?

Accepted Answer

$$	ext{Total Price} = (	ext{Manufacturing Cost}) + 0.15 	imes (	ext{Manufacturing Cost}) + 	ext{Pharmacy Labor} + 	ext{Shipping} + 	ext{Credit Card Processing Fee}$$

Question 6

Which of the following is a potential risk when patients use multiple pharmacies for their prescriptions?

Accepted Answer

Increased risk of drug interactions due to incomplete medication records.

Question 7

A Medicaid patient cannot afford their $4 copay for a preferred drug. What must the pharmacy do?

Accepted Answer

Dispense the medication even if the copay is not collected.

Question 8

Which of the following statements about Medicare Part D is TRUE after the implementation of the Inflation Reduction Act in 2025?

Accepted Answer

There is a $2,000 annual cap on out-of-pocket spending for prescription drugs.

Question 9

Which of the following is a function of Pharmacy Benefit Managers (PBMs)?

Accepted Answer

Processing claims between pharmacies and insurance companies.

Question 10

A patient is eligible for both Medicaid and the Children’s Health Insurance Program (CHIP). Which statement is most accurate?

Accepted Answer

CHIP covers children whose family income is too high for Medicaid but still cannot afford private insurance.

Question 11

Which of the following is a quality measure used in Medicare Part D plan star ratings?

Accepted Answer

Drug safety and plan finder pricing accuracy

Question 12

A pharmacist in Illinois wants to provide hormonal contraceptive assessment and consultation. What is required for reimbursement?

Accepted Answer

Completion of an approved educational training program and a standing order from a physician.

Question 13

Which of the following is a limitation of prescription savings programs (e.g., $4 generics)?

Accepted Answer

They may lead to incomplete prescription information in the health plan’s drug claims database.

Question 14

Which population is primarily served by Medicaid?

Accepted Answer

Low-income children, parents, expectant mothers, disabled, and low-income adults.

Question 15

Which of the following is a benefit of the Health Insurance Marketplace established by the ACA?

Accepted Answer

Allows side-by-side comparisons of private health insurance plans’ benefits, quality, and price.

Question 16

A pharmacy is being audited by a third-party payer. Which of the following is most likely to be reviewed?

Accepted Answer

Signature logs, policies and procedures, and formulas used for compounded prescriptions.

Question 17

Which of the following is TRUE regarding the Children’s Health Insurance Program (CHIP)?

Accepted Answer

It provides coverage for uninsured children whose families have incomes too high to qualify for Medicaid.

Question 18

Which of the following is a requirement for pharmacies to bill Medicare or Medicaid for services?

Accepted Answer

Pharmacies must be enrolled as providers under the respective program.

Question 19

Which of the following is a feature of Medicare Advantage (MA) plans?

Accepted Answer

They are provided by private insurance companies approved by Medicare and often include prescription drug coverage.

Question 20

Which of the following is a direct impact of the Inflation Reduction Act on Medicare Part D vaccine coverage?

Accepted Answer

Elimination of enrollee cost-sharing for recommended vaccines covered under Medicare Part D.

Insurance, Reimbursement, and Compensation in U.S. Healthcare

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