Practice Quiz

PTCE Pharmacy Technician

Category - Insurance

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Which of the following most accurately describes a prior authorization?
  1. When a patient's insurance company requires that the patient meets specific criteria before they will consider paying for a patient's prescription medication, the process of documenting that these criteria have been met by the doctor's office is called prior authorization
  2. When a patient is trying to fill a prescription for Acutance, this is the process the pharmacy must complete to obtain authorization to fill the prescription
  3. When a patient has run out of refills on their medication, this is the process the pharmacy must complete to obtain refill authorization from the doctor's office
  4. When a doctor wants to call in a prescription, this is the process they must go through in order to leave a voicemail for the pharmacist
Explanation
Answer: A - A prior authorization must be completed when a patient's insurance company requires that the patient meets specific criteria before they will consider paying for a patient's prescription medication. The doctor's office must complete paperwork and send to the insurance company or call the insurance company to document the prior treatments a patient has used. This must be done before the insurance company will consider covering the medication in question.
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