Practice Quiz

PTCE Pharmacy Technician

Category - Insurance

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On January 1, Mrs. Smith tries to fill her prescription for Januvia. Her insurance company returns the claim as paid, but with a very high co-payment, even though the last time she bought it in December it had a $10 co-payment. What is most likely the reason for this?
  1. The price for Januvia went up drastically
  2. Her insurance has been terminated
  3. Januvia is limited in availability so the price has increased
  4. She has not yet met her deductible for the New Year
Explanation
Answer: D - Mrs. Smith has most likely not yet met her deductible for the New Year. Some insurance plans have a deductible, a set amount the patient has to pay out of pocket, before the insurance company will begin covering their medications. This is often reflected through increased co-payments for patients who have not yet met their deductible. Many insurance companies renew the deductible at the beginning of the year.
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