DISPENSING THIRD-PARTY PRESCRIPTIONS

A pharmacy technician verifies eligibility and enters a claim into the pharmacy management system.

Which of the following actions should the technician take if the system rejects the claim?

• Resubmit the claim at a later time.

• Delete the claim and enter a new one.

• Ensure that the copayment has been collected and the deductible has been met.

• Double-check the accuracy of the entered information.

A pharmacy technician enters a refill request for a patient’s prescription of atorvastatin (Lipitor)

80 mg (quantity 30), and it is rejected. This is the third of six allowed refills. Which of the following

information might explain why this claim was rejected?

• The refill is too soon.

• The prescribed quantity is too much.

• The medication is restricted.

• There are too many refills allowed.

A one-time prescription for bimatoprost (Latisse) 0.03% for thin eyelashes is presented to a

pharmacy. When a pharmacy technician enters the information into the pharmacy management

system, the prescription is rejected for prior authorization. Which of the following actions should the

technician take?

• Re-enter the information into the system.

• Contact the pharmacy benefits manager.

• Change the medication to one that is covered.

• Notify the prescribing physician.

A prescription for rifaximin (Xifaxan) 550 mg is rejected by the pharmacy management system with

an alert that the medication is only covered for life-threatening conditions. Which of the following

actions should the pharmacy technician take?

• Inform the patient that the medication can be filled tomorrow.

• Check with the pharmacist to determine if there is a less expensive alternative.

• Resubmit the claim without refills and dispense the medication.

• Call the insurance company to get verbal authorization to fill the prescription.

Which of the following numbers should a pharmacy technician recognize as a six-digit number that

the pharmacy uses to identify which insurance provider should receive the claim?

• Member identification (ID) number

• B. Bank identification number (BIN)

• Processor control number (PCN)

• Group number

Which of the following occurs when a claim is adjudicated?

• The system conducts a prospective medication utilization review.

• The system checks the mechanism of action of the medication.

• The system checks the adverse effects of the medication.

• The system conducts a check of the chemical structure of the medication.

A 27-year-old patient presents their father’s pharmacy benefits card when dropping off a prescription

for 10 tablets of ciprofloxacin (Cipro) 500 mg. The patient states that they are a dependent on

the plan. The claim is rejected when adjudicated. Which of the following is the likely reason for

the rejection?

• The medication is not covered.

• The quantity prescribed is more than the maximum allowed.

• The patient is too old to be covered by their parent’s plan.

• The father is not present to sign for the prescription.

The last two digits of an NDC number refer to which of the following information about a specific

medication?

• Manufacturer

• Medication name

• Package size

• Medication strength

A patient who is obese presents a prescription for phentermine (Adipex-P) 37.5 mg, qd, #21 with 0

refills. When adjudicated by the computer system, the prescription is rejected. Which of the following

is a possible reason for the rejection?

• The technician has not received prior authorization.

• The prescribed quantity is considered excessive.

• The medication is not considered medically necessary.

• There are not enough refills.

A patient presents a pharmacy benefit card to a pharmacy with their parent’s name on it and says

that they are covered. A pharmacy technician reviews the card and finds that there are no dependent

names listed on the card. Which of the following actions should the technician take?

• Process the insurance card with the parent’s name on the claim.

• Charge the patient the copay, based on the computer adjudication.

• Call the toll-free number on the card to confirm with the pharmacy benefit manager.

• Refuse to process the card because the patient’s name must be on it.